TEST 5: Abuse and Mental Health Problems of Children, Adolescents, and Families

Question 1

The Client Experiencing Abuse
1. A married female client has been referred to the mental health center because she is depressed.
The nurse notices bruises on her upper arms and asks about them. After denying any problems, the
client starts to cry and says, “He didn’t really mean to hurt me, but I hate for the kids to see this. I’m so
worried about them.” Which of the following is the most crucial information for the nurse to
determine?
1. The type and extent of abuse occurring in the family.
2. The potential of immediate danger to the client and her children.
3. The resources available to the client.
4. Whether the client wants to be separated from her husband.

Answer 1

The Client Experiencing Abuse
1. 2. The safety of the client and her children is the most immediate concern. If there is immediate
danger, action must be taken to protect them. The other options can be discussed after the client’s
safety is assured.
CN: Psychosocial integrity; CL: Analyze

Question 2

2. A client with suspected abuse describes her husband as a good man who works hard and
   provides well for his family. She does not work outside the home and states that she is proud to be a
   wife and mother just like her own mother. The nurse interprets the family pattern described by the
   client as best illustrating which of the following as characteristic of abusive families?
3. Tight, impermeable boundaries.
4. Unbalanced power ratio.
5. Role stereotyping.
6. Dysfunctional feeling tone.

Answer 2

2. 3. The traditional and rigid gender roles described by the client are examples of role
      stereotyping. Impermeable boundaries, unbalanced power ratio, and dysfunctional feeling tone are
      also common in abusive families.
      CN: Safety and infection control; CL: Analyze

Question 3

3. When planning the care for a client who is being abused, which of the following measures is
   most important to include?
4. Being compassionate and empathetic.
5. Teaching the client about abuse and the cycle of violence.
6. Explaining to the client about the client’s personal and legal rights.
7. Helping the client develop a safety plan.

Answer 3

3. 4. The client’s safety, including the need to stay alive, is crucial. Therefore, helping the client
      develop a safety plan is most important to include in the plan of care to ensure the client’s safety.
      Being empathetic, teaching about abuse, and explaining the person’s rights are also important after
      safety is ensured.
      CN: Psychosocial integrity; CL: Synthesize

Question 4

4. A nurse is assessing a client who is being abused. The nurse should assess the client for which
characteristic? Select all that apply.
1. Assertiveness.
2. Self-blame.
3. Alcohol abuse.
4. Suicidal thoughts.
5. Guilt.

Answer 4

4. 2, 3, 4, 5. The victim of abuse is usually compliant with the spouse and feels guilt, shame, and
   some responsibility for the battering. Self-blame, substance abuse, and suicidal thoughts and attempts
   are possible dysfunctional coping methods used by abuse victims. The victim of abuse is not likely to
   demonstrate assertiveness.
   CN: Psychosocial integrity; CL: Analyze

Question 5

5. After months of counseling, a client abused by her husband tells the nurse that she has decided
   to stop treatment. There has been no abuse during this time, and she feels better able to cope with the
   needs of her husband and children. In discussing this decision with the client, the nurse should:
6. Tell the client that this is a bad decision that she will regret in the future.
7. Find out more about the client’s rationale for her decision to stop treatment.
8. Warn the client that abuse commonly stops when one partner is in treatment, only to begin again
   later.
9. Remind the client of her duty to protect her children by continuing treatment.

Answer 5

5. 2. The nurse needs more information about the client’s decision before deciding what
      intervention is most appropriate. Judgmental responses could make it difficult for the client to return
      for treatment should she want to do so. Telling the client that this is a bad decision that she will regret
      is inappropriate because the nurse is making an assumption. Warning the client that abuse commonly
      stops when one partner is involved in treatment may be true for some clients. However, until the nurse
      determines the basis for the client’s decision, this type of response is an assumption and therefore
      inappropriate. Reminding the client about her duty to protect the children would be appropriate if the
      client had talked about episodes of current abuse by her partner and the fear that her children might be
      hurt by him.
      CN: Psychosocial integrity; CL: Synthesize

Question 6

6. A third-grade child is referred to the mental health clinic by the school nurse because he is
   fearful, anxious, and socially isolated. After meeting with the client, the nurse talks with his mother,who says, “It’s that school nurse again. She’s done nothing but try to make trouble for our family since
   my son started school. And now you’re in on it.” The nurse should respond by saying:
7. “The school nurse is concerned about your son and is only doing her job.”
8. “We see a number of children who go to your son’s school. He isn’t the only one.”
9. “You sound pretty angry with the school nurse. Tell me what has happened.”
10. “Let me tell you why your son was referred, and then you can tell me about your concerns.”

Answer 6

6. 3. The mother’s feelings are the priority here. Addressing the mother’s feelings and asking for
      her view of the situation is most important in building a relationship with the family. Ignoring themother’s feelings will hinder the relationship. Defending the school nurse and the school puts the
      client’s mother on the defensive and stifles communication.
      CN: Psychosocial integrity; CL: Synthesize

Question 7

7. The mother of a school-aged child tells the nurse that, “For most of the past year, my husband
   was unemployed and I worked a second job. Twice during the year I spanked my son repeatedly when
   he refused to obey. It has not happened again. Our family is back to normal.” After assessing the
   family, the nurse decides that the child is still at risk for abuse. Which of the following observations
   best supports this conclusion?
8. The parents say they are taking away privileges when their son refuses to obey.
9. The child has talked about family activities with the nurse.
10. The parent’s are less negative toward the nurse.
11. The child wears long-sleeved shirts and long pants, even in warm weather.

Answer 7

7. 4. Parental use of nonviolent discipline, the child’s talk about what the family is doing and the
      easing of the parent’s negativity toward the school nurse are all signs of progress. Avoidance and
      wearing clothes inappropriate for the weather implies that the child has something to hide, likely
      signs of physical abuse.
      CN: Psychosocial integrity; CL: Analyze

Question 8

8. When caring for a client who was a victim of a crime, the nurse is aware that recovery from
   any crime can be a long and difficult process depending on the meaning it has for the client. Which of
   the following should the nurse establish as a victim’s ultimate goal in reconstructing his or her life?
9. Getting through the shock and confusion.
10. Carrying out home and work routines.
11. Resolving grief over any losses.
12. Regaining a sense of security and safety.

Answer 8

8. 4. Ultimately, a victim of a crime needs to move from being a victim to being a survivor. A
      reasonable sense of safety and security is key to this transition. Getting through the shock and
      confusion, carrying out home and work routines, and resolving grief over any losses represent steps
      along the way to becoming a survivor.
      CN: Psychosocial integrity; CL: Synthesize

Question 9

9. A client tells the nurse that she has been raped but has not reported it to the police. After
   determining whether the client was injured, whether it is still possible to collect evidence, and
   whether to file a report, the nurse’s next priority is to offer which of the following to the client?
10. Legal assistance.
11. Crisis intervention.
12. A rape support group.
13. Medication for disturbed sleep

Answer 9

9. 2. The experience of rape is a crisis. Crisis intervention services, especially with a rape crisis
      nurse, are essential to help the client begin dealing with the aftermath of a rape. Legal assistance may
      be recommended if the client decides to report the rape and only after crisis intervention services
      have been provided. A rape support group can be helpful later in the recovery process. Medications
      for sleep disturbance, especially benzodiazepines, should be avoided if possible. Benzodiazepines
      are potentially addictive and can be used in suicide attempts, especially when consumed with
      alcohol.
      CN: Psychosocial integrity; CL: Synthesize

Question 10

10. In working with a rape victim, which of the following is most important?
11. Continuing to encourage the client to report the rape to the legal authorities.
12. Recommending that the client resume sexual relations with her partner as soon as possible.
13. Periodically reminding the client that she did not deserve and did not cause the rape.
14. Telling the client that the rapist will eventually be caught, put on trial, and jailed.

Answer 10

10. 3. Guilt and self-blame are common feelings that need to be addressed directly and frequently.
       The client needs to be reminded periodically that she did not deserve and did not cause the rape.
       Continually encouraging the client to report the rape pressures the client and is not helpful. In most
       cases, resuming sexual relations is a difficult process that is not likely to occur quickly. It is not
       necessarily true that the rapist will be caught, tried, and jailed. Most rapists are not caught or
       convicted.
       CN: Psychosocial integrity; CL: Apply

Question 11

1. In the process of dealing with intense feelings about being raped, victims commonly verbalize
   that they were afraid they would be killed during the rape and wish that they had been. The nurse
   should decide that further counseling is needed if the client voices which of the following?
2. “I didn’t fight him, but I guess I did the right thing because I’m alive.”
3. “Suicide would be an easy escape from all this pain, but I couldn’t do it to myself.”
4. “I wish they gave the death penalty to all rapists and other sexual predators.”
5. “I get so angry at times that I have to have a couple of drinks before I sleep.

Answer 11

11. 4. Use of alcohol reflects unhealthy coping mechanisms. A client’s report of needing alcohol to
       calm down needs to be addressed. Survival is the most important goal during a rape. The client’s
       acknowledging this indicates that she is aware that she made the right choice. Although suicidal
       thoughts are common, the statement that suicide is an easy escape but the client would be unable to do
       it indicates low risk. Fantasies of revenge, such as giving the death penalty to all rapists, are natural
       reactions and are a problem only if the client intends to carry them out directly.
       CN: Psychosocial integrity; CL: Evaluate

Question 12

12. One of the myths about sexual abuse of young children is that it usually involves physicallyviolent acts. Which of the following behaviors is more likely to be used by the abusers?
13. Tying the child down.
14. Bribery with money.
15. Coercion as a result of the trusting relationship.
16. Asking for the child’s consent for sex.

Answer 12

12. 3. Coercion is the most common strategy used because the child commonly trusts the abuser.
       Tying the child down usually is not necessary. Typically, the abusive person can control the child by
       his or her size and weight alone. Bribery usually is not necessary because the child wants love and
       affection from the abusive person, not money. Young children are not capable of giving consent for
       sex before they develop an adult concept of what sex is.
       CN: Psychosocial integrity; CL: Apply

Question 13

13. A preadolescent child is suspected of being sexually abused because he demonstrates the
    self-destructive behaviors of self-mutilation and attempted suicide. Which common behavior should
    the nurse also expect to assess?
14. Inability to play.
15. Truancy and running away.
16. Head banging.
17. Overcontrol of anger.

Answer 13

13. 2. Truancy and running away are common symptoms for young children and adolescents. The
       stress of the abuse interferes with school success, leading to the avoidance of school. Running away
       is an effort to escape the abuse and/or lack of support at home. Rather than an inability to play or a
       lack of play, play is likely to be aggressive with sexual overtones. Children tend to act out anger
       rather than control it. Head banging is a behavior typically seen with very young children who are
       abused.
       CN: Psychosocial integrity; CL: Analyze

Question 14

14. Adolescents and adults who were sexually abused as children commonly mutilate
    themselves. The nurse interprets this behavior as:
15. The need to make themselves less sexually attractive.
16. An alternative to binging and purging.
17. Use of physical pain to avoid dealing with emotional pain.
18. An alternative to getting high on drugs.

Answer 14

14. 3. Dealing with the physical pain associated with mutilation is viewed as easier than dealing
       with the intense anger and emotional pain. The client fears an aggressive outburst when anger and
       emotional pain increase. Self-mutilation seems easier and safer. Additionally, self-mutilation may
       occur if the client feels unreal or numb or is dissociating. Here, the mutilation proves to the client that
       he or she is alive and capable of feeling. The client may want to be less sexually attractive, but this
       aspect usually is not related to self-mutilation. Binging and purging is commonly done in addition to,
       not instead of, self-mutilation. Although a few clients report an occasional high with self-mutilation,
       usually the experience is just relief from anger and rage.
       CN: Psychosocial integrity; CL: Analyze

Question 15

15. A young child who has been sexually abused has difficulty putting feelings into words. Which
    of the following should the nurse employ with the child?
16. Engaging in play therapy.
17. Role-playing.
18. Giving the child’s drawings to the abuser.
19. Reporting the abuse to a prosecutor.

Answer 15

15. 1. The dolls and toys in a play therapy room are useful props to help the child remember
       situations and re-experience the feelings, acting out the experience with the toys rather than putting the
       feelings into words. Role-playing without props commonly is more difficult for a child. Although
       drawing itself can be therapeutic, having the abuser see the pictures is usually threatening for the
       child. Reporting abuse to authorities is mandatory, but doesn’t help the child express feelings.
       CN: Psychosocial integrity; CL: Synthesize

Question 16

16. When working with a group of adult survivors of childhood sexual abuse, dealing with anger
    and rage is a major focus. Which strategy should the nurse expect to be successful? Select all that
    apply.
17. Directly confronting the abuser.
18. Using a foam bat while symbolically confronting the abuser.
19. Keeping a journal of memories and feelings.
20. Writing letters to the abusers that are not sent.
21. Writing letters to the adults who did not protect them that are not sent.

Answer 16

16. 2, 3, 4, 5. Using a foam bat while symbolically confronting the abuser, keeping a journal of
    memories and feelings, and writing letters about the abuse but not sending them are appropriate
    strategies because they allow anger to be expressed safely. Directly confronting the abuser is likely to
    result in further harm because the abusers commonly deny the abuse, rationalize about it, or blame the
    victim.
    CN: Psychosocial integrity; CL: Synthesize

Question 17

17. After a client reveals a history of childhood sexual abuse, the nurse should ask which of the
    following questions first?
18. “What other forms of abuse did you experience?”
19. “How long did the abuse go on?”
20. “Was there a time when you did not remember the abuse?”
21. “Does your abuser still have contact with young children?”

Answer 17

17. 4. The safety of other children is a primary concern. It is critical to know whether other
       children are at risk for being sexually abused by the same perpetrator. Asking about other forms of
       abuse, how long the abuse went on, and if the victim did not remember the abuse are important
       questions after the safety of other children is determined.
       CN: Psychosocial integrity; CL: Synthesize

Question 18

18. Which parental characteristic is least likely to be a risk factor for child abuse?
19. Low self-esteem.
20. History of substance abuse.
21. Inadequate knowledge of normal growth and development patterns.4. Being a member of a large family.

Answer 18

18. 4. From documented cases of child abuse, a profile has emerged of a high-risk parent as a
       person who is isolated, impulsive, impatient, and single with low self-esteem, a history of substance
       abuse, a lack of knowledge about a child’s normal growth and development, and multiple life
       stressors. Just because a parent comes from a large family, there is no increase in the incidence of the
       parent abusing their own children unless they possess the other risk factors.
       CN: Psychosocial integrity; CL: Apply

Question 19

19. When obtaining a nursing history from parents who are suspected of abusing their child,
    which of the following characteristics about the parents should the nurse particularly assess?
20. Attentiveness to the child’s needs.
21. Self-blame for the injury to the child.
22. Ability to relate the child’s developmental achievements.
23. Difficulty with controlling aggression.

Answer 19

19. 4. Parents of an abused child have difficulty controlling their aggressive behaviors. They may
       blame the child or others for the injury, may not ask questions about treatment, and may not knowdevelopmental information.
       CN: Psychosocial integrity; CL: Analyze

Question 20

20. A 3-year-old child with a history of being abused has blood drawn. The child lies very still
    and makes no sound during the procedure. Which of the following comments by the nurse would be
    most appropriate?
    “It’s okay to cry when something hurts.”
21. “That really didn’t hurt, did it?”
22. “We’re mean to hurt you that way, aren’t we?”
23. “You were very good not to cry with the needle.”

Answer 20

20. 1. It is not normal for a preschooler to be totally passive during a painful procedure.
       Typically, a preschooler reacts to a painful procedure by crying or pulling away because of the fear of
       pain. However, an abused child may become “immune” to pain and may find that crying can bring on
       more pain. The child needs to learn that appropriate emotional expression is acceptable. Telling the
       child that it really didn’t hurt is inappropriate because it is untrue. Telling the child that nurses are
       mean does not build a trusting relationship. Praising the child will reinforce the child’s response not
       to cry, even though it is acceptable to do so.
       CN: Psychosocial integrity; CL: Synthesize

Question 21

21. While interviewing a 3-year-old girl who has been sexually abused about the event, which
    approach would be most effective?
22. Describe what happened during the abusive act.
23. Draw a picture and explain what it means.
24. “Play out” the event using anatomically correct dolls.
25. Name the perpetrator.

Answer 21

21. 3. A 3-year-old child has limited verbal skills and should not be asked to describe an event,
       explain a picture, or respond verbally or nonverbally to questions. More appropriately, the child can
       act out an event using dolls. The child is likely to be too fearful to name the perpetrator or will not be
       able to do so.
       CN: Psychosocial integrity; CL: Synthesize

Question 22

22. Which of the following observations by the nurse should suggest that a 15-month-old toddler
    has been abused?
23. The child appears happy when personnel work with him.
24. The child plays alongside others contentedly.
25. The child is underdeveloped for his age.
26. The child sucks his thumb.

Answer 22

22. 3. An almost universal finding in descriptions of abused children is underdevelopment for
       age. This may be reflected in small physical size or in poor psychosocial development. The child
       should be evaluated further until a plausible diagnosis can be established. A child who appears happy
       when personnel work with him is exhibiting normal behavior. Children who are abused often are
       suspicious of others, especially adults. A child who plays alongside others is exhibiting normal
       behavior, that of parallel play. A child who sucks his thumb contentedly is also exhibiting normal
       behavior.
       CN: Psychosocial integrity; CL: Analyze

Question 23

23. When planning interventions for parents who are abusive, the nurse should incorporate
    knowledge of which factor as a common parental indicator?
24. Lower socioeconomic group.
25. Unemployment.
26. Low self-esteem.
27. Loss of emotional family attachments

Answer 23

23. 3. Parents who are abusive often suffer from low self-esteem, commonly because of the way
       they were parented, including not being able to develop trust in caretakers and not being encouraged
       or offered emotional support by parents. Therefore, the nurse works to bolster the parents’ self-
       esteem. This can be achieved by praising the parents for appropriate parenting. Employment and
       socioeconomic status are not indicators of abusive parents. Abusive parents usually are attached to
       their children and do not want to give them up to foster care. Parents who are abusive love their
       children and feel close to them emotionally.
       CN: Psychosocial integrity; CL: Analyze

Question 24

24. A 15-year-old boy has been shy and quiet throughout his schooling. In the past, he has been
    teased about being “big” and “fat,” leading him to get angry and fight those who called him names.
    This school year, he joined the wrestling team and showed some promise, though he had to lose
    weight to compete in a lower weight class. This spring his mother called the school nurse and said
    she had noticed that her son was wearing long-sleeved shirts all the time and spending a lot of time in
    the bathroom at home. She has seen scars on his wrists that the boy attributes to wrestling although the
    season has been over for awhile. She and the boy’s father are going through a contentious divorce that
    she thinks may be upsetting her son. In what order of priority from first to last should the school nurse
    initiate the following actions?1. Interview the teen about how he is handling the divorce, any bullying he may be experiencing,
    and his current grades.
25. Interview the mother further about the child’s early childhood and any potential antecedents to
    his current behavior.
26. Interview the father about his awareness of his son’s behavior and perspective concerning it as
    well as the relationship between him and his son.
27. Ask the boy about self-injury, depression, and suicidality in connection with the scars on his
    wrists.

Answer 24

24.
1. Interview the teen about how he is handling the divorce, any bullying he may be experiencing,
and his current grades.
4. Ask the boy about self-injury, depression, and suicidality in connection with the scars on his
wrists.
2. Interview the mother further about the child’s early childhood and any potential antecedents tohis current behavior.
3. Interview the father about his awareness of his son’s behavior and perspective concerning it as
well as the relationship between him and his son.
The nurse should talk to the boy directly about how he is dealing with the stresses in his life, but
he may not be forthcoming if the nurse approaches the self-injury first. Once the nurse has established
rapport and learned about the client’s view of his situation, it will be more likely that the client will
be honest about his self-injury and any depression or suicidal thoughts or plans he may have. Since
the mother called the nurse with her concerns about her son, a further interview with the mother
would be the next step to take. Because there is conflict in the home, it would be necessary to also
interview the father for his perspective of the situation. If he is not aware of his son’s self-injury, he
needs to be informed of it.
CN: Safety and infection control; CL: Create;

Question 25

ncluded a suggestive picture of himself and suggested the student send a similar picture. When the
student sent back a picture of himself dressed only in his boxers, the popular student sent it to all his
friends and encouraged them to pass it along. Soon the whole school had seen the picture identified as
“Joe’s Crotch.” The student was so distressed and mortified he tried to hang himself but was found by
his parent before he succeeded. Which of the following outcomes would be most realistic and
appropriate with regard to this situation? Select all that apply.
1. The Facebook privileges of all those who forwarded the message are revoked for a year.
2. All students in the school are educated about the risks of cyberbullying and how to respond to
it.
3. The popular student who sent the message to his friends is disciplined by the school
authorities.
4. Joe can use the Internet safely after being educated about cyberbullying and completing a safety
plan.
5. Through therapy, Joe learns social skills to improve his confidence level and help him relate to
peers more easily.

Answer 25

25. 2, 3, 4, 5. Education of all students in the school about cyberbullying is appropriate and
    possible as programs exist to educate students in many communities. That education and his therapy
    should enable Joe to eventually return to using the Internet safely and to feel more confidence
    interacting with classmates. Disciplining of the student who posted Joe’s picture by school authorities
    is appropriate and can be helpful in reducing further incidents of cyberbullying. It is unrealistic to
    think that all those who forwarded the message could be identified, much less taken off Facebook.
    CN: Psychosocial integrity; CL: Evaluate

Question 26

The Adolescent With Eating Disorders
26. The nurse is planning an eating disorder protocol for hospitalized clients experiencing
bulimia and anorexia. Which elements should be included in the protocol? Select all that apply.
1. Clients must eat within view of a staff member.
2. Clients are not told their weight and cannot see their weight while being weighed.
3. Clients are not allowed to discuss food or eating in groups or informal conversation with
peers.
4. Clients must rest within view of a staff member and not go to the bathroom for one-half hour to
an hour after eating.
5. Clients cannot participate in any groups after admission until they gain 1 lb (0.45 kg).

Answer 26

The Adolescent With Eating Disorders
26. 1, 2, 4. In hospital settings, clients are not allowed to know their weight at the time they are
being weighed to decrease obsessing about weight gain. They must also eat and rest in staff view and
cannot use the bathroom for a period to prevent discarding food or vomiting ingested food (purging).
The rest prevents the client from exercising off the calories they just consumed. Barring clients from
ever talking about food or attending groups until they have gained weight diminishes the therapeutic
value of the inpatient hospital stay.
CN: Psychosocial integrity; CL: Create

Question 27

27. A hospitalized adolescent diagnosed with anorexia nervosa refuses to comply with her daily
    before-breakfast weigh-in. She states that she just drank a glass of water, which she feels will
    unfairly increase her weight. What is the nurse’s best response to the client?
28. “You are here to gain weight so that will work in your favor.”
29. “Don’t drink or eat for 2 hours and then I’ll weigh you.”
30. “You must weigh in every day at this time. Please step on the scale.”
31. “If you don’t get on the scale, I will be forced to call your doctor.”

Answer 27

27. 3. In responding to the client, the nurse must be nonjudgmental and matter of fact. Telling her
       that weight gain is in her favor ignores the client’s extreme fear of gaining weight. Putting off the
       weigh-in for 2 hours allows the client to manipulate the nurse and interferes with the need to weigh
       the client at the same time each day. Threatening to call the doctor is not likely to build rapport or a
       working relationship with the client.
       CN: Psychosocial integrity; CL: Synthesize

Question 28

28. The nurse discovers that an adolescent client with anorexia nervosa is taking diet pills rather
    than complying with the diet. What should the nurse do first?
29. Explain to the client how diet pills can jeopardize health.
30. Listen to the client about fears of losing control of eating while being treated.
31. Talk with the client about how weight loss and emaciation worry the health care providers.
32. Inquire about worries of the client’s family concerning the client’s physical and emotional
    health.

Answer 28

28. 2. A client with anorexia nervosa commonly has an extreme fear of not being able to control
       weight. The nurse should address this fear. Explaining the dangers of diet pills or discussing health
       care provider or family concerns focuses on the effect of the client’s weight loss on other people
       rather than the client. Unless the client is motivated to stop, the client will likely not be successful.
       CN: Psychosocial integrity; CL: Synthesize

Question 29

29. When teaching a group of adolescents about anorexia nervosa, the nurse should describe this
    disorder as being characterized by which of the following?
30. Excessive fear of becoming obese, near-normal weight, and a self-critical body image.
31. Obsession with the weight of others, chronic dieting, and an altered body image.
32. Extreme concern about dieting, calorie counting, and an unrealistic body image.
33. Intense fear of becoming obese, emaciation, and a disturbed body image.

Answer 29

29. 4. An intense fear of becoming obese, emaciation, and a disturbed body image all are
       considered to be characteristic of anorexia nervosa. Near-normal weight is not associated with
       anorexia. The weight of others is not a primary factor. Concern about dieting is not strong enough
       language to describe the control of food intake in the individual with anorexia nervosa.
       CN: Psychosocial integrity; CL: Apply

Question 30

30. When developing a teaching plan for a high school health class about anorexia nervosa,
    which of the following should the nurse include as the primary group affected by this disease?
31. Women, age at onset between 12 and 20 years.
32. Men, onset during the college years.
33. Women, onset typically after 30 years.
34. Men, onset after 20 years.

Answer 30

30. 1. Anorexia nervosa occurs most commonly in girls and women, with the age at onset between
       12 and 20 years. It begins less commonly after 30 years. Although anorexia occurs in men, the
       prevalence rate is less than 5% to 10% of all cases of anorexia.
       CN: Psychosocial integrity; CL: Apply

Question 31

31. The parents of a newly diagnosed 15-year-old with anorexia nervosa are meeting with the
    nurse during the admission process. Which of the following remarks by the parents should the nurse
    interpret as typical for a client with anorexia nervosa?
32. “We’ve given her everything, and look how she repays us!”
33. “She’s had behavior problems for the past year both at home and at school.”
34. “She’s been a model child. We’ve never had any problems with her.”
35. “We have five children, all normal kids with some problems at times.”

Answer 31

31. 3. Parents commonly describe their child as a model child who is a high achiever and
       compliant. These adolescents are typically well liked by teachers and peers. It is not typical for
       behavior problems to be reported. The description about having given the child everything and being
       repaid is more likely to describe an adolescent who is exhibiting behavior problems.
       CN: Psychosocial integrity; CL: Analyze

Question 32

32. A young adult female client and her roommate go the emergency department due to
    gastrointestinal problems. The client reveals that she attends college and works at a coffee shop each
    evening. A diet history indicates that the client has unhealthy eating habits, commonly eating large
    amounts of carbohydrates and junk food with few fruits and vegetables. “Her stomach is upset a lot,”
    the roommate says. She further reports that the client is “in the bathroom all the time.” The nurse
    should refer the client to:
33. A mental health clinic.
34. A weight loss program.
35. An overeating support group.
36. The client’s family primary health care provider.

Answer 32

32. 1. The large carbohydrate intake and significant time in the bathroom are characteristics of
       bulimia. To address the problem, the client must obtain an evaluation of her physical and
       psychological status. Suggesting going to a weight loss program or overeating support group frames
       the problem as strictly a weight issue and ignores the psychological etiology of the problem. Seeing
       the family’s primary health care provider does not address the psychological aspect of the client’s
       illness, and the client must make the appointment herself.
       CN: Psychosocial integrity; CL: Apply

Question 33

33. A nurse is working with a client with bulimia. Which of the following goals should be
    included in the care plan? Select all that apply.
34. The client will maintain normal weight.
35. The client will comply with medication therapy.
36. The client will achieve a positive self-concept.
37. The client will acknowledge the disorder.
38. The client will never have the desire to purge again.

Answer 33

33. 1, 2, 3, 4. Because of the large number of calories ingested in a binge and the fact that a purge
    does not eliminate all calories consumed, the client with bulimia is of more normal weight but still
    must have a goal of maintaining that weight. Research has shown that selective serotonin reuptake
    inhibitors are effective in treating bulimia, and the client is usually amenable to taking the medication.
    The client with an eating disorder (bulimia and anorexia) has negative self-concepts that fuel her
    disordered eating, and attaining a positive self-concept is an appropriate goal. The nurse should work
    with the client with bulimia to help her recognize her eating as disordered. That recognition can make
    the client more amenable to treatment. It is not realistic to establish a goal that the client with bulimia
    will never have the desire to purge again.
    CN: Psychosocial integrity; CL: Create

Question 34

34. A nurse works with a client diagnosed with bulimia. What is an appropriate long-term client
    goal for this client?
35. Eating meals at home without binging or purging.
36. Being able to eat out without binging or purging.
37. Managing stresses in life without binging or purging.
38. Being able to attend college in another state without binging or purging.

Answer 34

34. 3. A successful outcome for a bulimic client is to avoid using the eating disorder as a coping
       measure when dealing with stress. Being able to attend college in another state, eat at home, and eat
       out without binging and purging are important goals, but do not address the primary problem of stress
       management and its connection to eating.
       CN: Psychosocial integrity; CL: Create

Question 35

35. While coaching a youth soccer team, the nurse has observed one of the teammates binging and
    purging on multiple occasions. The nurse asks the girl’s mother to stay after practice and talk
    privately. Which of the following ways is best for the nurse to begin the conversation?
36. “Thank you for letting your daughter play on the team. She’s a very good player and is also
    pleasant and easy to coach.”
37. “I have some very bad news for you. Your daughter has a serious problem that is diagnosed as
    an eating disorder.”
38. “I am a nurse. I have seen your daughter doing things that are considered to be part of an eating
    disorder.”
39. “Let me get right to the point. Your daughter is very sick and needs to see a mental health
    therapist right away.”

Answer 35

35. 3. By telling the mother that the coach is a nurse and relaying the behaviors observed, the
       nurse gives the mother a chance to recognize the expertise of the coach and introduces the possibility
       of an eating disorder. Thanking the mother and complimenting the player does not begin to approach
       the topic. Telling the mother that the nurse has some very bad news is negative and dramatic.
       Additionally, although the observed behaviors suggest an eating disorder, it would be inappropriatefor the nurse to medically diagnose the daughter. Although the daughter may indeed be very sick and
       need to see a therapist, the nurse should relate the information in a matter-of-fact, unemotional way.
       CN: Psychosocial integrity; CL: Synthesize

Question 36

36. A client newly diagnosed with bulimia is attending the nurse-led group at the mental health
    center. She tells the group that she came only because her husband said he would divorce her if she
    didn’t get help. Which of the following responses by the nurse is appropriate?
37. “You sound angry with your husband. Is that correct?”
38. “You will find that you like coming to group. These people are a lot of fun.”
39. “Tell me more about why you are here and how you feel about that.”
40. “Tell me something about what has caused you to be bulimic.”

Answer 36

36. 3. Encouraging the client to talk about why she is here and her feelings may reveal more
       information about what led her to come to the group and what led to her diagnosis. It also provides
       the nurse with valuable information needed to develop an appropriate plan of care. The comment that
       the client sounds angry presumes what the client is feeling and focuses the talk on her husband. The
       focus should be on the client, not the husband. Telling the client that she will like coming to group
       imposes the nurse’s view onto the client. The statement also focuses on having fun in the group instead
       of stressing the therapeutic value. Having the client tell the nurse something about the cause of her
       bulimia ignores the client’s original statement. In addition, it requires the client to have insight into the
       cause of her disease, which may not be possible at this point. Also, it may be too early in the
       relationship to discuss this disorder.
       CN: Psychosocial integrity; CL: Synthesize

Question 37

37. A client diagnosed with bulimia tells the nurse she only eats excessively when upset with her
    best friend, and then she vomits to avoid gaining a lot of weight. The nurse should next:
38. Schedule daily family therapy sessions.
39. Enroll client in a coping skills group.
40. Work with the client to limit her purging.
41. Have client take lorazepam (Ativan) 1 mg as needed whenever she feels the urge to binge.

Answer 37

37. 2. Because the client eats excessively when upset, the best treatment would be a group to help
       her learn alternative coping skills. Trying to limit purging without controlling binging would result in
       weight gain and likely increase the client’s purging. Daily family therapy sessions are not realistic.
       Taking lorazepam whenever she feels she needs to binge may temporarily calm the client, but does not
       address the cause of the binging and purging and further, will lead to drug dependence with long-term
       use.
       CN: Psychosocial integrity; CL: Synthesize

Question 38

38. During the initial interview, a client with a compulsive eating disorder remarks, “I can’t stand
    myself and the way I look.” Which of the following statements by the nurse is most therapeutic?
39. “Everyone who has the same problem feels like you do.”
40. “I don’t think you look bad at all.”
41. “Don’t worry, you’ll soon be back in shape.”
42. “Tell me more about your feelings.”

Answer 38

38. 4. The nurse needs to explore more about the client’s feelings to assess what underlies the
       eating disorder. The nurse also needs to evaluate the client’s suicide risk. The other statements are not
       therapeutic because they minimize the client’s feelings.
       CN: Psychosocial integrity; CL: Synthesize

Question 39

39. A community health nurse working with a group of fifth-grade girls is planning a primary
    prevention to help the girls avoid developing eating disorders during their teen years. The nurse
    should focus on which of the following?
40. Working with the school nurse to closely monitor the girls’ weight during middle school.
41. Limiting the girls’ access to media images of very thin models and celebrities.
42. Telling the girls’ parents to monitor their daughter’s weight and media access.
43. Helping the girls accept and appreciate their bodies and feel good about themselves

Answer 39

39. 4. The goal of a primary prevention program for eating disorders is for the girls to have
       positive feelings about themselves and their bodies. Monitoring of weight by parents and/or school
       nurses might note eating disorders early, particularly anorexia, but will not address the cause of the
       disorder. Limiting the girls’ access to media would be impossible and does not prevent distress with
       one’s body image.
       CN: Psychosocial integrity; CL: Synthesize

Question 40

Children and Adolescents With Behavior Problems
40. A 17-year-old client who has been taking an antidepressant for 6 weeks has returned to the
clinic for a medication check. When the nurse talks with the client and her mother, the mother reports
that she has to remind the client to take her antidepressant every day. The client says, “Yeah, I’m pretty
bad about remembering to take my meds, but I never miss a dose because Mom always bugs me about
taking it.” Which of the following responses would be effective for the nurse to make to the client?
1. “It’s a good thing your mom takes care of you by reminding you to take your meds.”
2. “It seems there are some difficulties with being responsible for your medications that we need to
address.”
3. “You’ll never be able to handle your medication administration at college next year if you’re so
dependent on her.”
4. “I’m surprised your mother allows you to be so irresponsible.”

Answer 40

Children and Adolescents With Behavior Problems
40. 2. The client and mother need to address the issue of responsibility for medication
administration. Reinforcing the mother’s overinvolvement in medication taking or making negative
comments about the client and mother t are unlikely to engage them in problem solving about the
matter.
CN: Psychosocial integrity; CL: Synthesize

Question 41

41. The school nurse assesses a 10-year-old girl who excessively cleans and categorizes. Her
    parents report that she has always been orderly, but since her brother died of cancer 6 months ago, her
    cleaning and categorizing have escalated. In school, she reads instead of playing with other children.
    These behaviors are now interfering with homework and leisure activities. To bolster her self-
    esteem, the nurse should encourage the child to:
42. Be a library helper.
43. Organize a party for the class.
44. Be in charge of a group project with four peers.
45. Be captain of the kickball team.

Answer 41

41. 1. This child is demonstrating signs of anxiety and withdrawal. Being a library helper enables
       the client to use an interest (reading) when interacting with others and gaining pride in helping others.
       Most interaction will be one-to-one and with adults, which is likely to be more comfortable for her inher state of anxiety. Organizing a class party, a group project with her peers, and a kickball team
       involve multiple peer interactions, which are likely to be difficult for her at this time. Also, there is
       no mention of the child liking sports, so kickball would not be an appropriate activity.
       CN: Psychosocial integrity; CL: Synthesize

Question 42

42. A 13-year-old junior high school student has come to the school nurse, stating that her father
    has physically abused her for 3 years. Initially, the client accepted the abuse, thinking it was because
    her father had been laid off, but the abuse continued after he got a job 4 months ago. She fears that her
    mother will not believe her and her father will reject her if they discover she has revealed the abuse.
    The nurse should first:
43. Inform the mother in a face-to-face meeting without the girl present.
44. Call the father, confront him, and then call the police to have him arrested.
45. Meet with both parents together. Include the daughter in the meeting so she can speak for
    herself.
46. Report the alleged abuse to Child Protective Services (Ministry of Children and Family) that
    day, and then provide for the child’s safety.

Answer 42

42. 4. All suspected child abuse must be reported, but this child’s age and ability to describe the
       abuse make this allegation particularly strong. Because parental reaction to her allegation is not
       predictable, the nurse must ensure the child’s safety. The nurse should not discuss the situation with
       the client or the parents. The nurse must refer this case to Child Protective Services (the Ministry of
       Children and Family).
       CN: Management of care; CL: Synthesize

Question 43

43. A 15-year-old is a heavy user of marijuana and alcohol. When the nurse confronts the client
    about his drug and alcohol use, he admits previous heavy use in order to feel more comfortable
    around peers and achieve social acceptance. He says he has been trying to stay clean since his parents
    found out and had him seek treatment. When the nurse develops a plan of care with the client, what
    should be the highest priority to help him maintain sobriety?
44. Peer recognition that does not involve substance use.
45. Support and guidance from his parents.
46. A strict no-drug policy at his high school.
47. The threat of legal charges if caught drinking or smoking marijuana.

Answer 43

43. 1. Peer acceptance and recognition is a very powerful force in the lives of adolescents,
       leading to positive or negative behavior depending on the child’s peers. While the influence of
       parents remains strong, peer acceptance combined with the adolescent’s desire for independence can
       lead to disobeying the parents. The sanctions provided at school and in the community by law
       enforcement will support those teens that have other support in their lives, but are generally not
       sufficient to prevent substance use in adolescents lacking support at home and with peers.
       CN: Psychosocial integrity; CL: Create

Question 44

44. A 17-year-old is admitted to a psychiatric day treatment program due to severe lower back
    pain since her mother’s death 3 years ago. Medical examinations have not discovered a physical
    cause for her pain. She cares for her four younger siblings after school and on weekends because of
    her father’s long work hours. Which predischarge statement indicates that treatment for her condition
    has been successful?
45. “I understand now why my father spends so much time away from home.”
46. “My back pain is worse on weekends with more chores and homework.”
47. “I don’t want to talk about my family. It’s my back that is hurting.”
48. “I just need more rest and relaxation and then my back will feel fine.”

Answer 44

44. 2. This statement indicates insight into possible emotional causes for her pain. After insight is
       achieved, the client can make behavior changes to effectively cope with her anxiety-related disorder.
       Saying that she understands why her father is away so often demonstrates insight into her father’s
       actions rather than her own. Wanting to discuss her pain and not her family indicates denial of any
       connection between her pain and her stress, which perpetuates her current situation. While rest may
       help her back, the client’s statement does not address psychological issues related to the back pain.
       CN: Psychosocial integrity; CL: Evaluate

Question 45

45. When collaborating with the health care provider to develop the plan of care for a child
    diagnosed with attention deficit hyperactivity disorder (ADHD), the treatment plan will likely include
    which of the following?
46. Antianxiety medications, such as buspirone (BuSpar), and homeschooling.
47. Antidepressant medications, such as imipramine (Tofranil), and family therapy.
48. Anticonvulsant medications, such as carbamazepine (Tegretol), and monthly blood levels.
49. Psychostimulant medications, such as methylphenidate (Ritalin), and behavior modification.

Answer 45

45. 4. ADHD is typically managed by psychostimulant medications, such as methylphenidate and
       pemoline (Cylert), along with behavior modification. Antianxiety medications, such as buspirone, are
       not appropriate for treating ADHD. Homeschooling commonly is not a possibility because both
       parents work outside the home. Antidepressants, such as imipramine, are not recommended for use in
       children. Family therapy may be a part of the treatment. Anticonvulsant medications, such as
       carbamazepine, are not appropriate for ADHD. Also, carbamazepine levels are obtained weekly
       early during therapy to avoid toxicity and ascertain therapeutic levels.
       CN: Pharmacological and parenteral therapies; CL: Apply

Question 46

46. The nurse meets with the mother of a child diagnosed with attention deficit hyperactivity
    disorder. The mother states, “I feel so guilty that he has this disease, like I did something wrong. I feel
    like I need to be with him constantly in order for him to get better. But still sometimes I feel like I’m
    going to lose control and hurt him.” The nurse should suggest which of the following to the mother?
47. Arranging for respite care to watch her child and give herself a regular break.
48. Taking a job to allow herself to feel some success because her child won’t ever improve.
49. Arranging to have coffee with friends daily as a way to begin a support group.
50. Considering foster care if she feels that she can’t handle her child’s problems.

Answer 46

46. 1. Suggesting that the mother arrange for respite care so that she can have a regular break
       would help to alleviate some of the stress that she feels when she is with her child constantly. The
       mother also could use family and friends to provide some care, thereby helping with giving her a
       break. The child may improve, so suggesting that the mother take a job to provide a feeling of success
       would be inappropriate. Having coffee daily with friends may provide some opportunities for
       socialization. However, friends may not be able to provide the verbal support that the mother needs.
       Rather, attending a support group of other parents with children with attention deficit hyperactivity
       disorder might be helpful. Placing the child in foster care is an extreme measure that may damage the
       therapeutic relationship with the nurse and dramatically and negatively affect the relationship
       between the mother and child.CN: Psychosocial integrity; CL: Synthesize

Question 47

47. The nurse is with the parents of a 16-year-old boy who recently attempted suicide. The nurse
    cautions the parents to be especially alert for which of the following in their son?
48. Expression of a desire to date.
49. Decision to try out for an extracurricular activity.
50. Giving away valued personal items.
51. Desire to spend more time with friends.

Answer 47

47. 3. Giving away personal items has consistently been shown to be an indicator of suicide plans
       in a depressed and suicidal individual. Expression of a desire to date, trying out for an extracurricular
       activity, or the desire to spend more time with friends indicates a return of interest in normal
       adolescent activities.
       CN: Psychosocial integrity; CL: Analyze

Question 48

48. A 19-year-old has struggled academically throughout high school and realizes during her last
    semester in school that she is not going to graduate with her class, which will delay her admission to
    college. In the past, she has intermittently used drugs and alcohol to deal with her anxiety, but now her
    involvement with substances escalates to daily use. In what order of priority from first to last should
    the school nurse, who has become aware of the problem, take the following actions?
49. Refer her to the school authorities to address her academic issues so she can graduate next
    semester.
50. Refer her to a program at the local community college to improve the client’s readiness for
    college and decrease her anxiety.3. Refer her to an outpatient program that treats clients with chemical dependency issues.
51. Refer her to a psychiatric clinic so she can get an appropriate diagnosis and medication for
    her anxiety.

Answer 48

48.
4. Refer her to a psychiatric clinic so she can get an appropriate diagnosis and medication for
her anxiety.
3. Refer her to an outpatient program that treats clients with chemical dependency issues.
1. Refer her to the school authorities to address her academic issues so she can graduate next
semester.
2. Refer her to a program at the local community college to improve the client’s readiness for
college and decrease her anxiety.
The client’s anxiety seems to fuel her substance abuse, so treatment for her anxiety is paramount,
followed by treatment for substance abuse. Those two interventions should increase her readiness to
profit from academic aid offered by the school. Referral to a community college program would help
her get ready for college, which will likely decrease her anxiety.
CN: Psychosocial integrity; CL: Create

Question 49

49. A mother states to the nurse in her primary care provider’s office that she is frustrated
    regarding her 7-year-old son’s nightly enuresis for the past 3 years. She says she has limited his
    evening fluids, eliminated all caffeine and soft drinks from his diet, and has had him wash his own
    sheets, but he still wets the bed almost every night. Her husband has told her he was a bed wetter as a
    child. He thinks the son will “get over it.” The mother is worried that it could negatively affect the
    son’s peer relationships as he grows older. Which of the following actions should the nurse take?
50. Tell the mother her husband is correct and she should be patient since her husband’s enuresis
    stopped without intervention.
51. Suggest asking the primary care provider about medication treatment to deal with the enuresis.
52. Discuss a behavioral treatment plan for the child focusing on the improvement of his social
    skills.
53. Suggest the mother ask the primary care provider about hospitalization for a complete renal
    workup since the enuresis has gone on a long time

Answer 49

49. 2. The mother’s distress and length of time the problem has existed combined with the efforts
       she has made to address the problem demonstrate that medication treatment should be considered.
       The absence of any other symptoms make a renal workup unnecessary at this time. It is unlikely that
       social skills training alone will change his nocturnal enuresis. Just waiting for the behavior to stop is
       likely to further tax the mother and son.
       CN: Psychosocial integrity; CL: Create

Question 50

50. A parent of a 7-year-old diagnosed with attention deficit hyperactivity disorder (ADHD)
    since he was 5 years old is talking to the school nurse about her concerns about the son’s physical
    condition. The parent states that his medication, Concerta (methylphenidate extended release),
    controls his symptoms well but is causing him to lose weight. It is difficult to get him up and ready for
    school in the morning unless he is given the medication as soon as he awakens. Then he does not eat
    breakfast or very much of his lunch at school. He eats dinner, but only an average amount of food. He
    has lost 3 lb (1.4 kg) in the last 2 weeks. Which of the following should the nurse suggest the parent
    do first?
51. Have the child eat a breakfast bar, banana, and a glass of milk at his bedside at the same time
    he takes his Concerta every morning.
52. Monitor the child’s weight closely for a month since he is likely to stop losing weight when the
    school year ends in 2 weeks.
53. Suggest a change of medication to a nonstimulant drug that will treat his ADHD without
    causing the appetite decrease.
54. Suggest that the parent supplement the child’s dinner with a high-protein drink or other food
    that will increase his caloric intake

Answer 50

50. 1. Because weight loss is a common side effect of methylphenidate and because the child’s
       symptoms are controlled with the stimulant, the first action should be to increase the child’s oral
       intake before the medication’s side effects begin. Weight should be monitored, but since the child has
       already lost weight, a remedy is needed as well as monitoring. The weight loss is directly due to the
       medication’s side effects, so the child will continue to lose weight unless an intervention is made
       whether or not he is enrolled in school or on summer vacation. A high-protein drink could work, but
       then the child is taking in all his calories in the evening, which is not best nutritionally. A change of
       medication should be the last resort since methylphenidate is the most effective medication for ADHD
       and has been successful with this child.CN: Pharmacological and parenteral therapies; CL: Analyze

Question 51

51. An adolescent is brought to the Emergency Department (ED) after accidentally taking an
    overdose of heroin (the strength of the heroin he got was greater than the heroin he had been taking).The adolescent is semiconscious, unable to respond appropriately to questions, slurs his words, has
    constricted pupils, and vital signs of blood pressure 60/50, pulse 50, and respirations 8. Narcan
    (nalaxone acetate) is administered to temporarily reverse the effects of the heroin. Which of the
    following would first indicate that the Narcan administration had been effective?
52. The client’s blood opiate level drops to a nontoxic level.
53. The client becomes talkative and physically active.
54. The client’s memory and attention become normal.
55. The client’s respirations improve to 12/min.

Answer 51

51. 4. Decreased respirations and coma are the two most dangerous effects of heroin overdose, so
       an increase in respirations after administration of the Narcan demonstrates initial effectiveness of the
       medication. Changes in cognition and psychomotor activity will take more time to become apparent.
       The client’s blood opioid level may not drop to a nontoxic level for a few days.
       CN: Pharmacological and parenteral therapies; CL: Evaluate

Question 52

52. Assessment of suicidal risk in children and adolescents requires the nurse to know which of
    the following?
53. Children rarely commit suicide unless one of their parents has already committed suicide,
    especially in the past year.
54. The risk of suicide increases during adolescence, with those who have recently suffered a loss,
    abuse, or family discord being most at risk.
55. Children do have a suicidal risk that coincides with some significant event such as a recent gun
    purchase in the family.
56. Adolescents typically don’t choose suicide unless they live in certain geographical regions of
    the United States and Canada.

Answer 52

52. 2. Adolescents are more likely than children to attempt or commit suicide. Loss, abuse, and
       family discord remain significant risk factors. There is no evidence to support that children rarely
       commit suicide. Additionally, evidence fails to support the belief that children who have lost a parent
       to suicide will attempt it themselves. Significant events, such as a recent firearm purchase, have not
       been linked to suicide attempts in children. No geographical region in the United States or Canada is
       free from adolescent suicide.
       CN: Psychosocial integrity; CL: Apply

Question 53

53. A child with Asperger’s disorder is being referred to the mental health clinic along with his
    parents. To provide the best care for this family, the nurse makes a care plan based on the fact that this
    disorder differs from autism in which of the following areas?
54. Asperger’s disorder, commonly diagnosed earlier than autism, is associated with fewer major
    problems in interpersonal interactions.
55. In Asperger’s disorder, behavior commonly is similar to that of other children with autism but
    without the problems with school.
56. Asperger’s disorder is recognized later than autism, and interpersonal interaction problems
    typically become more apparent when the child begins school.
57. There are significant problems with language development, as with autism, but there are no
    delays or difficulties with motor development.

Answer 53

53. 3. Asperger’s disorder is recognized later than autism, and the interpersonal problems worsen
       with school attendance. These children usually have restricted and repetitive patterns of behavior.
       School problems exist as a result of the interaction difficulties and behavior differences. Motor
       development may be delayed, but language commonly progresses normally.
       CN: Psychosocial integrity; CL: Apply

Question 54

54. The mother of a 14-year-old girl who is diagnosed with oppositional defiant disorder tells
    the nurse that she has read extensively on this disorder and does not believe the diagnosis is correct
    for her daughter. Which of the following responses by the nurse is appropriate?
55. “It sounds like you are very interested in your daughter. Let’s focus on what is best for her.”
    “Tell me what you have found in your reading that is leading you to that conclusion.”
56. “Your doctor has had many years of education and experience, so you can believe he’s right.”
57. “That doesn’t matter now because we just need to help her get better.”

Answer 54

54. 2. The nurse needs to find out what exactly the mother knows and has read. Reviewing what
       the mother has found in her reading that is leading her to doubt the diagnosis will help direct the
       nurse’s teaching and clarify any misperceptions or misinformation that the mother may have. The
       primary health care provider may indeed have many years of education and experience, and the focus
       should be on the daughter, but the nurse needs to address the mother’s concerns at this time.
       CN: Psychosocial integrity; CL: Synthesize

Question 55

55. The parents of a preschool child diagnosed with autism must take their child on a plane flight
    and are concerned about how they can make the experience less stressful for her and their fellow
    travelers. The nurse in their psychiatrist’s office suggests a dry run to the airport in which they
    simulate going through security and boarding a plane. In addition, the nurse suggests taking items to
    help the child be calm during the flight. In what order of priority from first to last should the parents
    employ the items listed below?1. A DVD player with headphones and favorite games, cartoons, and child films.
56. A favorite stuffed toy animal or other soft toy.
57. A favorite nonelectronic game.
58. Medication that can be given as needed to calm the child.

Answer 55

55.
1. A DVD player with headphones and favorite games, cartoons, and child films.
3. A favorite nonelectronic game.
2. A favorite stuffed toy animal or other soft toy.
4. Medication that can be given as needed to calm the child.
Electronic games and stories are favorites of most children, but are particularly enjoyed by
children on the autism spectrum. The headphones block out some of the noises that might be upsetting
to a child on the autism spectrum. If the child cannot be engaged electronically, a favorite
nonelectronic toy would be the next choice. Stuffed animals or other soft toys can soothe a child who
is starting to become upset. Medication should be a last resort as it can have a paradoxical effect if itis an antianxiety medication or may cause too much sedation during the flight.
CN: Psychosocial integrity; CL: Create

Question 56

56. A young school-age girl whose mother and aunt have been diagnosed as having bipolar
    disorder and whose father is diagnosed with depression is brought to the child psychiatrist’s office by
    her father who has custody since the parents divorced. The father has brought the child to the office
    because of problems with behavior and attention in school and inability to sleep at night. The child
    says, “My brain doesn’t turn off at night.” The psychiatrist diagnoses the child as experiencing
    attention deficit hyperactivity disorder (ADHD) with a possibility of bipolar disorder as well as the
    ADHD. What should the office nurse say to the father to explain what the psychiatrist said? Select all
    that apply.
    “The psychiatrist diagnosed your child as having ADHD because of her attention and behavior
    problems at school.”
    “ADHD involves difficulty with attention, impulse control, and hyperactivity at school, home, or in
    both settings.”
57. “The psychiatrist does not know how to diagnose your child’s illness since she has symptoms
    of both bipolar disorder and ADHD.”
58. “The child’s description of her inability to sleep is irrelevant to diagnosing her condition since
    she stays up late.”
59. “The psychiatrist is considering a bipolar diagnosis because of your child’s family history of bipolar
    disorder and her sleep issues.”

Answer 56

56. 1, 2, 5. The client’s school problems, the presence of first-degree relatives diagnosed with
    bipolar disorder and depression, and her inability to sleep at night mirror aspects of both ADHD and
    bipolar disorder, which are difficult to distinguish from each other in children. Psychiatrists are
    reluctant to diagnose young children as bipolar at this age. She may have only one disorder or the
    other or both. Further monitoring and her response to medication will differentiate whether she is
    suffering from one of the disorders or both. Any comments indicating that the psychiatrist does not
    know what he or she is doing or that the child’s perceptions of her illness are not valid will
    undermine any trust the father and child might be developing in their caregiver and so should be
    avoided.
    CN: Psychosocial integrity; CL: Apply

Question 57

57. At the admission interview, the father of a 4-year-old boy with attention deficit hyperactivity
    disorder (ADHD) says to the nurse, “I know that my wife or I must have caused this disease.” Which
    of the following is the nurse’s best response?
58. “ADHD is more common within families, but there is no evidence that problems with parenting
    cause this disorder.”
59. “What do you think you might have done that could have led to causing this disorder to develop
    in your son?”
60. “Many parents feel this way, but I doubt there is anything that you did that caused ADHD to
    develop in your child.”
61. “Let’s not focus on the cause but rather on what needs to be done to help your son get better. I
    know that you and your wife are very interested in helping him to improve his behavior.”

Answer 57

57. 1. Stating that attention deficit hyperactivity disorder occurs more commonly in families takes
       the opportunity for teaching while also helping the father realize that he and his wife are not to blame.
       Parents who are commonly blamed by society for their child’s behavior need help with education.
       Questioning the father on what he thinks he may have done implies that the parents played some role
       in this disorder, possibly contributing to the father’s guilt. Telling the father that many parents feel this
       way and that the nurse does not think the parents are at fault is premature at this point. Telling the
       father that he should focus on what needs to be done, rather than what caused the disorder, minimizes
       the father’s concerns and feelings.
       CN: Psychosocial integrity; CL: Synthesize

Question 58

58. A member of a nurse-led group for depressed adolescents tells the group that she is not
    coming back because she is taking medication and no longer needs to talk about her problems. Which
    of the following responses by the nurse is most appropriate?
59. “I’m glad that you are taking your medication, but how can we know that you will continue to
    take it? After all, you haven’t been on it for very long and you might decide to stop taking it.”
60. “I think that it is important to let everyone respond to what you said, so let’s go around the
    group and let everyone give their thoughts about what you have decided.”
61. “The purpose of the group is to provide each of you with a place to discuss the problems of being a
    teenager with depression with others who also are experiencing a similar situation.”
62. “You don’t have to stay in the group if you don’t want to, but if you choose to leave, then you
    won’t be able to change your mind later and return to the group.”

Answer 58

58. 3. Focusing on the purpose of the group is the best response. Adolescents are greatly
       influenced by their peers. Medication alone is not typically the most successful treatment strategy.
       Questioning whether the client will continue the medication is negative and is not the reason for her to
       stay in the group. Asking the rest of the group to respond may or may not give the nurse support for the
       teenager remaining in the group. Groups commonly have rules regarding movement of members in and
       out of the group, but this does not address the reasons for the client to remain in the group.
       CN: Psychosocial integrity; CL: Synthesize

Question 59

59. When assessing a 17-year-old male client with depression for suicide risk, which of the
    following questions is best?
60. “What movies about death have you watched lately?”
61. “Can you tell me what you think about suicide?”
62. “Has anyone in your family ever committed suicide?”
63. “Are you thinking about killing yourself?

Answer 59

59. 4. Asking whether the client is thinking about killing himself is the most direct and therefore
       the best way to assess suicidal risk. Knowing whether the client has watched movies on suicide and
       death, what the client thinks about suicide, and whether other family members have committed suicide
       will not tell the nurse whether the client is thinking about committing suicide right now.
       CN: Psychosocial integrity; CL: Analyze

Question 60

60. A teacher is talking to the school nurse about a child in her classroom who has a tic disorder.
    The teacher mentions that the boy frequently trips other children although no one has ever been hurt.
    The teacher then further states that she ignores him when that happens because it is part of his
    disorder. The nurse should tell the teacher:
61. “Tripping other children is not a tic, so you can respond to that as you would in any other child.”
62. “I can’t believe that you actually allow him to get away with that!”
63. “I think that is the best choice unless some parents of the other children start to protest about
    it.”
64. “If no one else is getting hurt, then it seems harmless and might prevent the development of a
    worse behavior.”

Answer 60

60. 1. The teacher needs to be informed that this behavior is inappropriate. Therefore, educating
       the teacher and encouraging her to respond to misbehavior consistently is correct. Telling the teacher
       that the nurse can’t believe the teacher lets the child get away with the behavior is demeaning and
       condescending. Allowing the child to continue the misbehavior is counterproductive to discipline and
       could create other problems.
       CN: Psychosocial integrity; CL: Synthesize

Question 61

61. A 15-year-old boy being successfully treated for Tourette’s syndrome tells the nurse, “I’m not
    going to take this medication anymore. Anyone who is really my friend will accept me as I am, tics
    and all!” The nurse should tell the client:
62. “You and your family came to the clinic for treatment, so you can terminate it whenever you
    wish.”
63. “Won’t your lack of medication cause more tics and make you be less attractive to girls?”
64. “Let’s talk about what brought you into treatment and why you now want to stop taking medication.”
65. “I think that is a very unwise decision, but you’re entitled to do whatever you wish.”

Answer 61

61. 3. When an adolescent wants to stop treatment with medication, it represents a desire for more
       control over his/her life as well as a wish to be free of the disorder with which they have beendiagnosed. If the caregiver merely acknowledges the client’s right to stop treatment or warns of
       consequences if the client stops medication, he or she abdicates the adult role of health care advisor.
       Before any action is taken, the nurse should explore the client’s reasoning to see if anything in the
       medication regimen could be changed to make it more palatable for the client. The client also needs
       to know that if his current objections cannot be overcome, he can return later to restart his medication.
       CN: Psychosocial integrity; CL: Synthesize

Question 62

62. The nurse leading a group session for parents of children diagnosed with oppositional defiant
    disorder. The nurse should give which of the following recommendations for discipline?
63. Avoid limiting the child’s use of the television and computer for punishment.
64. Be consistent with discipline while assisting with ways for the child to more positively
    express anger and frustration.
65. Use primarily positive reinforcement for good behavior while ignoring any demonstrated badbehavior.
66. Use time-out as the primary means of punishment for the child regardless of what the child has
    done.

Answer 62

62. 2. Consistent discipline and alternative methods of anger management are two important tools
       for parents who have a child with oppositional defiant disorder. Consistent discipline sets limits for
       the child. Helping the child learn more appropriate ways to manage anger assists the child in living
       within societal expectations. Avoiding restriction of television and computer time for punishment or
       using time-out as the primary means of punishment has not been suggested as an appropriate
       management method. Typically, using many strategies is more effective. Ignoring bad behavior could
       be dangerous and does not reinforce to the child that limits on behavior exist in society.
       CN: Psychosocial integrity; CL: Synthesize

Question 63

63. A 15-year-old girl is sent to the school nurse with dizziness and nausea. While assessing the
    girl, who denies any health problems, the nurse smells alcohol on her breath. Which of the following
    responses by the nurse is most appropriate?
64. “Don’t tell me that you have been drinking alcohol before you came to school this morning!”
65. “Why don’t you tell me the real reason that you are feeling sick this morning?”
    “Tell me everything that you have had to eat and drink yesterday and today.”
66. “I know that high school is stressful, but drinking alcohol is not the best way to handle it.”

Answer 63

63. 3. Asking the client to report everything that she has had to eat and drink yesterday and today
       is the least judgmental approach and also provides helpful information. Confronting the client about
       drinking alcohol or asking the client to admit the real reason for feeling sick can put the girl on the
       defensive and block further communication. The nurse should avoid putting the client on the defensive
       to facilitate communication that may eventually enable the nurse to get the truth and identify
       interventions.
       CN: Psychosocial integrity; CL: Synthesize

Question 64

64. Parents of a 7-year-old child newly diagnosed with attention deficit hyperactivity disorder
    (ADHD) ask the nurse whether their son will always have to take medication for this condition. The
    nurse should tell the parents:
65. “Yes, almost everyone with this disorder has to continue taking medication forever.”
66. “Between one-third and one-half of children experiencing ADHD and taking medication will need to
    continue to take medication as adults.”
67. “Most children with this disorder do not need to continue taking medications as adults.”
68. “There is just a small percentage of adults with ADHD who can manage without medications.”

Answer 64

64. 2. Studies show that usually one-third to one-half of people diagnosed with ADHD do not
       need medication as adults.
       CN: Psychosocial integrity; CL: Synthesize

Question 65

65. Which of the following should the nurse include in the teaching plan for the parents of a child
    who is receiving methylphenidate (Ritalin)?
66. Giving the medication at the same time every evening.
67. Having the child take two doses at the same time if the last dose was missed.
68. Giving the single-dose form of the medication early in the day.
69. Allowing concurrent use of any over-the-counter medications with this drug.

Answer 65

65. 3. The single-dose form of methylphenidate should be taken 10 to 14 hours before bedtime to
       prevent problems with insomnia, which can occur when the daily or last dose of the medication is
       taken within 6 hours (for multiple dosing) or 10 to 14 hours (for single dosing) before bedtime. It is
       recommended that a missed dose be taken as soon as possible; the dose is skipped if it is not
       remembered until the next dose is due. Any other medication, including over-the-counter medications,
       should be discussed with the health care provider before use to eliminate the risk of a possible drug
       interaction.
       CN: Pharmacological and parenteral therapies; CL: Create

Question 66

66. An 8-year-old child was recently hospitalized at a child psychiatric unit for inattention and
    acting out behavior at school and home. His psychiatrist prescribed the methylphenidate/ritalin patch
    to control his attention deficit hyperactivity disorder symptoms, and inpatient unit staff worked with
    him on behavioral control measures. The office nurse discovers at his first visit after his discharge
    from the hospital that the boy has been taking off his patch during the day, which is causing problems
    at school and at home. In which order of priority from first to last should the nurse take the following
    actions?
67. Explain to the family, in terms the child can understand, the benefits of his medication in
    dealing with school and home problems he is experiencing.
68. Explore the parents’ attitudes about medication administration in general and their child’s
    medication in particular.
69. Explore the child’s reasons for removing the patch during the day rather than at the end of the
    day.4. Have the psychiatrist discuss with the child and parents a trial of a different medication.

Answer 66

66.
3. Explore the child’s reasons for removing the patch during the day rather than at the end of the
day.
2. Explore the parents’ attitudes about medication administration in general and their child’s
medication in particular.1. Explain to the family, in terms the child can understand, the benefits of his medication in
dealing with school and home problems he is experiencing.
4. Have the psychiatrist discuss with the child and parents a trial of a different medication.
First, the child’s reasons for removing the patch need to be explored to determine what needs to
be done to solve the problem of inadequate medication administration. Since the child is probably
heavily influenced by his parents’ attitudes about taking medications, their attitudes need to be
addressed next to determine if they openly or subtly oppose the medication or its method of
administration. Once the knowledge of the child’s and parent’s feelings about medication are known,
education can be offered to be sure the child understands how the medication can help him cope
better in school and home. If the child continues to take off his patch or demonstrates an allergic
response to the patch or if it is determined that his parents are not supportive of the patch, discussion
of a trial of another medication to treat the child’s symptoms should occur.
CN: Pharmacological and parenteral therapies; CL: Create

Question 67

67. A 7-year-old client is diagnosed with conduct disorder. After admission, the nurse identifies
    his problematic behaviors as cruelty to animals, stealing, truancy, aggression with peers, lying, and
    explosive angry outbursts resulting in destruction of property. The nurse is now talking with the client
    about his behavioral contract, which should include which crucial components? Select all that apply.
68. Taking prescribed medications.
69. Acceptable methods for expressing anger.
70. Consequences for unacceptable behaviors.
71. Rules for interacting with staff and other clients.
72. Personal possessions allowed on the unit.

Answer 67

67. 1, 2, 3, 4. The crucial elements of a behavioral contract include compliance with the
    medication regimen if medication is prescribed, appropriate anger management, consequences for
    unacceptable behaviors, and rules for interactions with others. Personal possessions may be limited
    by unit rules, but are not part of an individualized behavioral contract.
    CN: Psychosocial integrity; CL: Create

Question 68

68. The nurse is meeting weekly with an adolescent recently diagnosed with depression to
    monitor progress with therapy and antidepressant medication. The nurse should be most concerned
    when the client reports which of the following?
69. An acquaintance hung herself 2 days ago.
70. She is experiencing intermittent headaches as a side effect of taking the antidepressant.
71. She received a low score on her last history test.
72. Her younger brother has been starting fights with her for the last week.

Answer 68

68. 1. While all the occurrences could upset the client in the early stage of treatment, the one
       involving the most risk to safety is the suicide completion of a peer. Adolescents are susceptible to
       “copycat” suicides. The fact that she knows the method of suicide of the acquaintance and is at a
       critical period in treatment, when her antidepressant may have given her increased energy while still
       experiencing low self-esteem, can put her at significant risk for suicide.
       CN: Safety and infection control; CL: Analyze

Question 69

The Child and Adolescent with Adjustment
Disorders
69. A 19-year-old male is seriously ill with cystic fibrosis (CF), which he has had since infancy.
He is frequently hospitalized for lung infections and is in need of a lung transplant. However, he has a
rare blood type that complicates the process of obtaining a donor organ. He has also been diagnosed
with bipolar disorder and treated successfully since midadolescence with medication and therapy.
How should the nurse on the unit on which he is hospitalized for pneumonia interpret his request for a
chaplain to help him make plans for a funeral and donation of his body to science after death?
1. It is a signal of the depressive side of his bipolar disorder, and he should be checked for
suicidal thoughts/plans.
2. It is a signal of an exacerbation of the client’s CF and warrants further assessment by his lung
specialist.
3. It is a signal of the client’s awareness he is likely to have a shortened life span and should be
supported by unit staff.
4. It is a signal of delirium as a result of the many medications he is taking and requires further
assessment by the pharmacist or primary care provider

Answer 69

The Child and Adolescent With Adjustment Disorders
69. 3. A client who has endured serious chronic illness (both psychiatric and medical) would be
well aware of his shortened lifespan, particularly if he is unable to get a lung transplant. It would not
be unusual for him to want to plan ahead, so his wishes would be honored in the event of his death. In
the absence of other physical signs, an exacerbation of CF or delirium is not demonstrated. Likewise,
his successful bipolar treatment in the absence of any other signs rules depression out as a reason for
his behavior. Though it may be difficult for us to think about a young person in terms of dying, the
client’s consideration of the future is a rational decision.
CN: Psychosocial integrity; CL: Analyze

Question 70

70. A 6-year-old boy has experienced the death of his mother in the last 3 months. He and his
    father are involved in a grief support program that has sessions for all ages. A nurse is educating the
    parents about the normal grief reactions of children to help them distinguish normal behavior from
    behavior that is unusual and possibly indicative of depression or other psychological issues. Which
    of the following represents normal grief behavior for this young child after the death of his mother?
    Select all that apply.
71. Talking to his mother as if she were present in the room.
72. Crying followed in a few minutes by laughing.
73. Playing with a rope, saying he is going to be with his mother.
74. Yelling and being angry at his mother for leaving him.
75. Playing with a friend right after saying he misses his mother.

Answer 70

70. 1, 2, 4, 5. Young children cannot be sad all the time after a loss, but that does not mean they
    grieve less. Their moods change more quickly and they often work out their issues through play rather
    than talking. Because young children do not have a full understanding of death’s finality, they may talk
    to a deceased loved one as if they are present. They also may not understand the circumstances of the
    death and so may think the loved one left voluntarily and be angry at the deceased for leaving them.Play involving a dangerous object such as a rope, coupled with a stated desire to join the deceased
    parent, would be cause for alarm as the child could harm himself either purposely or accidentally.
    CN: Psychosocial integrity; CL: Apply

Question 71

71. When counseling a 5-year-old girl who recently suffered the loss of her mother, which of the
    following statements reflects the typical understanding about death at this age?
72. “My mommy died last week, but I’m going to see her again.”
73. “My daddy said mommy went to heaven, and I’m glad Jesus took her there.”
74. “My dog died and now we got another one.”
75. “I think Mommy went to heaven and I’ll get to see her someday when I die.”

Answer 71

71. 1. Five-year-old children view death as reversible, so talking about seeing her mother again
       is a normal statement for a child of this age. A child this age would not usually state that she was glad
       Jesus took her mom but instead might be afraid that Jesus would also take her or her dad. The idea of
       replacing her mother with a new one, as hinted in the statement that they got another dog after the dog
       died, has not been supported by studies of grieving children. Stating that mommy went to heaven and
       that the child will see her someday when the child dies is reflective of more advanced abstract
       thinking than a 5-year-old would demonstrate.
       CN: Health promotion and maintenance; CL: Analyze

Question 72

72. A shy 12-year-old girl who must change school systems just before she begins junior high
    school begins cutting her arms to relieve the stress that she feels about leaving long-standing friends,
    having to develop new friendships, and meeting high academic standards in her new school. After she
    has been cutting for a few weeks, her parent discovers the injuries and takes her to a psychiatrist who
    prescribes a therapeutic group at the local mental health center and medication to help decrease her
    anxiety. The nurse who is leading the group would determine that the girl had made appropriate
    progress toward recovery when which of the following occurred? Select all that apply.
73. The girl indicated that she had joined three clubs at school and agreed to be an officer in one of them.
74. The girl says she has developed a friendship with a girl in her class and one in her therapy group.
75. The girl wears short-sleeved and/or sleeveless tops when the weather is warm.
76. The girl’s grades are good, and her hours of study are not excessive.
77. The girl begins saying she must study hard so she can get into a good university.

Answer 72

72. 2, 3, 4. The development of friendships and good grades with moderate amounts of study are
    positive signs since friends and grades in the new school were sources of stress and anxiety for the
    girl. The ability to wear clothes appropriate to the weather rather than hiding her arms is a sign she is
    no longer injuring her arms. Joining three clubs and being an officer in one of them is unlikely and
    would probably be an additional source of stress for the girl as would be pushing herself to
    extraordinary academic achievement to secure a place in college when she has just entered junior
    high.
    CN: Psychosocial integrity; CL: Evaluate;

Question 73

Managing Care Quality and Safety
73. Which of the following children should the nurse identify as being more at risk for an episode
of major depression?
1. A 16-year-old male, who has been struggling in school, making only Cs and Ds.
2. A 13-year-old female, who was upset over not being chosen as a cheerleader.
3. A 10-year-old male, who has never liked school and has few friends.
4. A 14-year-old, who recently moved to a new school after her parents’ divorce.

Answer 73

Managing Care Quality and Safety
73. 4. Children who experience serious losses, especially multiple losses, such as old friends or
a parent, are more at risk for depression. Girls also are at greater risk than boys during the adolescent
years.
CN: Health promotion and maintenance; CL: Analyze

Question 74

74. A staff nurse on the mental health unit tells the nurse manager that kids with conduct disorders
    might as well be jailed because they all end up as adults with antisocial personality disorder anyway.
    What is the best reply by the nurse manager?
75. “You really sound burned out. Do you have a vacation coming up soon?”
76. “These children are more likely to have problems with depression and anxiety disorder as adults.”
77. “You sound really frustrated. Let’s talk about the meaning of their behavior.”
78. “My experience hasn’t been that negative. Let’s see what the other staff members think; maybe I’m wrong.”

Answer 74

74. 3. The nurse manager needs to focus on the frustration that the nurse is expressing.
       Additionally, the nurse manager needs to correct any misinformation or misinterpretation that the staff
       nurse has. Saying that the nurse sounds burned out and asking about a vacation does not focus on the
       nurse’s frustration or address the inaccuracy of the nurse’s statement. There is no evidence to suggest
       that children with conduct disorder have more than the average adult’s risk of depression or anxiety.
       Therefore, this response is inaccurate and inappropriate. Anecdotal information from personal
       experience does not supply the nurse with accurate, reliable information.
       CN: Management of care; CL: Synthesize

Question 75

75. Which of the following children should the nurse assess as demonstrating behaviors that need
    further evaluation?
76. Joey, age 2, who refuses to be toilet-trained and talks to himself.
77. Adrienne, age 6, who sucks her thumb when tired and has never spent the night with a friend.
78. Curt, age 10, who frequently tells his mother that he is going to run away whenever they argue.
79. Stephen, age 2, who is indifferent to other children and adults and is mute.

Answer 75

75. 4. Indifference to other people and mutism may be indicators of autism and would require
       further investigation. A 2-year-old who talks to himself and refuses to cooperate with toilet training is
       displaying behaviors typical for this age. Occasional thumb sucking and not having spent the night
       with a friend would be normal at age 6. Threats to run away when angry is considered within the
       range of normal behaviors for a 10-year-old child.
       CN: Health promotion and maintenance; CL: Analyze

Question 76

76. A nurse has been caring for a 12-year-old adolescent client in a residential facility. The child
    has been through a series of foster placements since infancy with no success in any placement until the
    age of 7 when placed with a middle-aged single woman. The client thrived there until the woman was
    killed in a car accident. The client attempted suicide after her foster mother died in response to the
    loss and the child was placed in the residential facility. The nurse has become close to this client and
    wants to help her address her issues and move on with her life. Which of the following comments to
    the manager demonstrates that the nurse understands the client’s issues and is able to respond
    appropriately to the client’s needs?
77. “It’s difficult for her to love and trust again after her losses. In this facility, she can learn to deal with
    her loss in a less emotionally charged environment than a foster home.”
78. “She just needs someone who will love her and give her the things she has missed out on in
    life. An adoptive family needs to be found for her as soon as possible.”
79. “I’m not sure she is going to be able to get past all the loss and rejection she’s experienced. I
    don’t think adoption will ever be a viable option for her.”
80. “I know her well and am familiar with her issues. I think the best chance for success for her
    would be if she was adopted into my family.”

Answer 76

76. 1. The severe emotional trauma the girl has experienced will likely make it difficult for her to
       be successful in an adoptive placement at the present time, whether that placement is with someoneshe knows (the nurse) or another adoptive family. Additionally, adoption by the nurse is inappropriate
       because it blurs the lines between her professional and personal life and is likely to confuse the
       client. It is clear that the client has many issues and that love alone is not likely to solve all her
       problems. Treatment at the residential facility will allow her to work through emotional issues in a
       more therapeutic environment. Though not currently ready for adoption, she may be ready for
       adoption in the future after sufficient treatment.
       CN: Management of care; CL: Evaluate

Question 77

77. Which of the following adolescents would the nurse determine needs further evaluation?
78. A young adolescent girl whose mood changes when upset with her parents, though she has
    never been in trouble in school or the community.
79. A young adolescent boy who coughs for 5 minutes after trying his first marijuana cigarette and
    declares he does not want to do it again.
80. A young adolescent boy who restricts his food and fluid intake in order to be able to box in a
    lower weight class.
81. A young adolescent girl who reads “dark” novels and questions why God allows innocent
    people to be harmed.

Answer 77

77. 3. Restricting intake to lose weight is a first step toward an eating disorder for males as well
       as females, so this behavior should be investigated further, especially since males of this age are
       usually unconcerned about their weight. Quick mood changes are common in young adolescents,
       particularly girls. Such mood changes should not be considered problematic if the adolescent is not
       experiencing trouble in major areas of his/her life. Experimenting with alcohol or other substances is
       fairly common in the teen years, but one or two uses do not generally lead to addiction. The negative
       effect of the coughing may be a deterrent to further use. Religious questioning and exploration of
       “dark” subjects is common among teens and is part of the development of mature thinking. In the
       absence of other signs of depression, it does not warrant further evaluation.
       CN: Management of care; CL: Evaluate

Question 78

78. A new client has just been admitted to an adolescent psychiatric inpatient unit. The charge
    nurse and an aide are discussing the client’s needs. The aide says, “She is just showing off to try and
    get our sympathy. There is no need for her to cut herself. Why would adolescents want to do such a
    thing to themselves?” Which of the following responses by the charge nurse would most help the aide
    understand the client and her illness?
79. “She is not doing the cutting for attention since she always wears clothing that covers up her
    injuries and further, she is not willing to talk about it.”
80. “It is hard to see a young person harm herself as she does, but she has serious family issues and does
    not know better ways to handle them, so we have to help her with that.”
81. “You do not understand her problems and do not take them seriously, so you should not be
    allowed to work with her during her hospitalization.”
82. “Perhaps you should transfer to another unit where you are able to have empathy for the
    clients.”

Answer 78

78. 2. The aide is concerned about the behavior of the client and confused about why it is
       occurring, so the nurse needs to explain a bit about the issues involved as well as demonstrate
       empathy for the aide. It is appropriate to explain that the client is not cutting for attention, but the
       nurse’s response does not address the reason for the teen’s behavior so is inadequate and sounds a
       little like the nurse is denigrating the aide, which will not encourage the aide to listen to what she has
       to say. The comments that the aide cannot work with the client or that she should transfer are punitive
       and do nothing to help the aide understand self-mutilation.
       CN: Management of care; CL: Analyze