Psychosocial Problems in Children and Families

MULTIPLE CHOICE

1. A nurse is assessing a child with a depressive disorder. Which symptom is likely to be manifested by the child?

a.
Increased nighttime waking
b.
Impulsivity and distractibility
c.
Carelessness and inattention to details
d.
Refusal to leave the house

ANS: A

Sleep pattern disturbances are often associated with depression. These include insomnia or hypersomnia. Impulsivity and distractibility are manifestations of attention-deficit hyperactivity disorder (ADHD). A diminished ability to think or concentrate, carelessness, and inattention to details are clinical manifestations of a depressive disorder. A refusal to leave the house, even to play with friends, is characteristic of separation anxiety disorder.

DIF: Cognitive Level: Application REF: p. 775

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

2. A nurse is teaching parents about symptoms associated with suicide. Which statement about suicide should the nurse include in the teaching plan?

a.
Children younger than 10 years of age do not attempt suicide.
b.
A child who attempts suicide is usually depressed and has low self-esteem.
c.
Suicide is usually an isolated event in a school community.
d.
The suicide rate among females is higher than among males.

ANS: B

Poor self-concept and depression contribute significantly to suicidal behaviors. Children as young as 3 years of age who have attempted suicide have been evaluated and found to be cognizant of their actions. It is common for suicide to occur in a cluster within a community (e.g., schools). Males have a higher incidence of both suicide attempts and completed suicides.

DIF: Cognitive Level: Application REF: p. 776

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

3. What is the best response for the nurse to make to an adolescent who states, “I am very sad. I wish I wasn’t alive.”?

a.
“Everyone feels sad once in a while.”
b.
“You are just trying to escape your problems.”
c.
“Have you told your parents how you feel?”
d.
“Have you thought about hurting yourself?”

ANS: D

“Have you thought about hurting yourself?” acknowledges the adolescent’s suicide gesture and further assesses the adolescent’s condition. “Everyone feels sad once in a while” is a judgmental response that ignores the adolescent’s obvious statement indicating a need for professional help. The parents should be made aware of an adolescent’s precarious mental state; however, “Have you told your parents how you feel?” does not address the adolescent’s statement.

DIF: Cognitive Level: Application REF: pp. 777-778

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

4. A nurse is teaching parents about family relationship patterns associated with eating disorders. Which family relationship pattern should the nurse teach that is consistent for an adolescent female diagnosed with an eating disorder?

a.
The adolescent is viewed as an extension of the parent.
b.
There is an overprotective mother and an emotionally distant father.
c.
The mother is domineering and the father is passive.
d.
The adolescent is the youngest child or is an only child.

ANS: A

One of the most salient factors associated with eating disorders is enmeshed family relationships in which the child is considered to be an extension of the parent or is viewed as a means of meeting the parents’ needs. The family dynamics for males with anorexia are reported to include a mother who is overinvolved with the child and a father who typifies a strong, cultural image. A domineering mother and passive father are not characteristic of the family dynamics associated with eating disorders. Birth order and number of children in the family were not identified as factors in enmeshed family relationships.

DIF: Cognitive Level: Application REF: p. 781

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

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

a.
managing the effects of malnutrition.
b.
establishing sufficient caloric intake.
c.
improving family dynamics.
d.
restructuring the perception of body image.

ANS: D

The focus of treatment in individual therapy for an eating disorder involves restructuring cognitive perceptions about the individual’s body image. The treatment of eating disorders is initially focused on reestablishing physiological homeostasis. Once body systems are stabilized, the next goal of treatment for eating disorders is maintaining adequate caloric intake. Although family therapy is indicated when dysfunctional family relationships exist, the primary focus of therapy for eating disorders is to help the adolescent cope with complex issues.

DIF: Cognitive Level: Comprehension REF: p. 782

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

6. A parent of a child with a psychosocial disorder states, “I don’t know how my child developed this problem.” The nurse should base a response on which information?

a.
Neurobiological, family, and sociocultural factors can contribute to the development of psychosocial disorders in children.
b.
Like many conditions affecting children, the etiology of psychosocial disorders is unknown.
c.
The majority of psychosocial disorders have a clear pattern of genetic inheritance.
d.
Dysfunctional family patterns are usually identified as the cause of a psychosocial disorder.

ANS: A

Psychosocial disorders are responses to stress and may be manifested as disturbances in feeling, body functions, behavior, or performance. The etiology of many psychosocial disorders in children can be identified. Some psychosocial disorders are inheritable disorders. Others have been identified as having a familial predisposition. Research consistently shows that psychosocial disorders are caused by a combination of predisposing or inherent factors and environmental or interactional factors.

DIF: Cognitive Level: Comprehension REF: p. 769

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

7. A nurse is caring for a child admitted for substance abuse. The nurse plans care with the recognition that substance abuse primarily affects which organ of the body?

a.
Heart
b.
Liver
c.
Brain
d.
Lungs

ANS: C

The primary affect of substance abuse is on the brain and residually on the rest of the body. Although an excessive amount of a chemical can cause cardiac abnormalities, the brain is the most commonly affected organ. Long-term alcohol use is known to impair the liver; however, brain function is decreased by any amount of alcohol intake. The pulmonary system is not the primary target; however, one commonly abused drug known to cause pulmonary problems is tobacco.

DIF: Cognitive Level: Implementation REF: p. 785

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

8. A 14-year-old child admits to using marijuana every day. Which phase of substance abuse should the nurse assess for?

a.
Experimentation
b.
Early drug use
c.
True drug addiction
d.
Severe drug addiction

ANS: C

True drug addiction is identified as regular use of drugs. Physical dependence may be present. Social functioning has a drug focus. With experimentation, the individual tries the drug to see what it is like or to satisfy peers. Early drug use is identified as using drugs with some degree of regularity for their desirable effects. In severe drug addiction, the physical condition of the individual deteriorates and all activities are related to drug use.

DIF: Cognitive Level: Comprehension REF: p. 784

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

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

a.
Physical abuse
b.
Physical neglect
c.
Emotional abuse
d.
Sexual abuse

ANS: B

These physical and behavioral indicators suggest that parental attention is not being given to the child’s physical needs. The child is being neglected. There are no physical indicators of actual abuse in this description. Behavioral indicators of physical abuse reflect an impaired relationship with parents and other adults. Emotional abuse is manifested by developmental problems or maladaptive behaviors. Physical indicators of sexual abuse are focused on the genitourinary system. A variety of behavioral indicators range from bizarre sexual behavior to eating and sleeping disturbances.

DIF: Cognitive Level: Comprehension REF: p. 788

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

10. Which should be the most appropriate nursing intervention for the infant who is not gaining weight?

a.
Instruct the primary caregiver on proper feeding techniques.
b.
Observe and document the parent–infant interaction.
c.
Assign different nurses to care for the infant.
d.
Feed the infant on a predetermined schedule.

ANS: B

Observation and documentation of the parent–infant interaction may offer insight into the cause of malnutrition. Instruction alone is not the best teaching strategy. Role modeling and supervised practice along with parental instruction will facilitate the parent’s learning to feed the infant. A consistent caregiver will facilitate trust in the infant. The infant’s caloric intake is increased by feeding the infant on demand rather than on a schedule.

DIF: Cognitive Level: Application REF: p. 788

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

11. Which statement made by a parent of a toddler who is not gaining weight indicates the need for education about feeding small children?

a.
“He doesn’t want to eat, so I put the cereal in his bottle.”
b.
“I put him in a high chair for meals and snacks.”
c.
“I turn off the television and we eat together for every meal.”
d.
“I try to feed him at the same times every day.”

ANS: A

Large quantities of cereal or baby food in bottles do not provide sufficient nutritional intake for the small child. The young child should be placed in a high chair for feeding. Distraction during feedings, such as watching television, is identified as a reason for inadequate nutritional intake in young children. Having the parents or others eat with the child makes meals and snacks a pleasant time. A regular pattern or schedule for meals facilitates nutritional intake.

DIF: Cognitive Level: Comprehension REF: p. 791

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

12. Which intervention should the nurse teach parents about caring for an infant experiencing drug withdrawal?

a.
Keep rooms in the home well lighted.
b.
Play music or the television continuously.
c.
Organize care to minimize disruptions.
d.
Let the infant calm himself if irritable.

ANS: C

The infant’s care should be coordinated to limit the number of times the infant is disturbed. Light levels should be maintained at the minimum necessary level. Sound levels should be kept to the minimum necessary level. Comfort measures should be provided immediately when the infant exhibits irritability.

DIF: Cognitive Level: Application REF: pp. 786-787

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

13. A child who has symptoms of irritable mood and changes in sleep and appetite patterns lasting 3 weeks meets the criteria for which depressive disorder?

a.
Major depressive disorder
b.
Dysthymic disorder
c.
Cyclothymic disorder
d.
Panic disorder

ANS: A

A 2-week (or longer) episode of depressed or irritable mood in addition to disturbances in appetite, sleep, energy, or self-esteem meets the criteria for a major depressive disorder. A dysthymic disorder is associated with a depressed or irritable mood for at least a year. A cyclothymic or bipolar mood disorder is characterized by chronic, fluctuating mood disturbances between depressive lows and highs for a year. A panic disorder is a type of anxiety disorder.

DIF: Cognitive Level: Comprehension REF: p. 773

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

14. What is the goal of therapeutic management for a child diagnosed with attention-deficit hyperactivity (ADHD) disorder?

a.
Administer stimulant medications.
b.
Assess the child for other psychosocial disorders.
c.
Correct nutritional imbalances.
d.
Reduce the frequency and intensity of unsocialized behaviors.

ANS: D

The primary goal of therapeutic management for the child with ADHD is to reduce the intensity and frequency of unsocialized behaviors. Although medications are effective in managing behaviors associated with ADHD, all families do not choose to give their child medication. Administering medication is not the primary goal. Children with ADHD may have other psychosocial or learning problems; however, diagnosing these is not the primary goal. Interventions to correct nutritional imbalances are the primary focus of care for eating disorders.

DIF: Cognitive Level: Comprehension REF: p. 779

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

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

a.
States feelings of worthlessness
b.
Increased desire for social conformity
c.
Does not feel the need for peer approval
d.
Rebellious behavior

ANS: D

Rebellious or aggressive behavior is a behavior that may indicate substance abuse. Feelings of worthlessness are suggestive of a depressive disorder. An adolescent with a substance abuse problem may be depressed, but this behavior is not a manifestation of substance abuse. The clinical manifestations of substance abuse are marked by an increase in antisocial behavior as the desire for social conformity decreases and the need for the substance increases. The adolescent with a substance abuse problem may demonstrate an excessive dependence on peer influence.

DIF: Cognitive Level: Comprehension REF: p. 785

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

16. A nurse is caring for an infant with neonatal abstinence syndrome. Which manifestation should the nurse expect to assess?

a.
Weight gain
b.
Respiratory acidosis
c.
High-pitched persistent cry
d.
Hypotonus

ANS: C

A high-pitched persistent cry is one of the many manifestations of infant drug withdrawal. The infant undergoing drug withdrawal may lose weight or fail to gain weight. Respiratory alkalosis and respiratory distress are manifestations of withdrawal. An infant undergoing drug withdrawal would have hypertonus, hyperreflexia, and hyperactivity.

DIF: Cognitive Level: Analysis REF: p. 786

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

17. Which finding noted by the nurse on a physical assessment may suggest that a child has been sexually abused?

a.
Swelling of the genitalia and pain on urination
b.
Smooth philtrum and thin upper lip
c.
Speech and physical development delays
d.
History of constipation, drowsiness, and constricted pupils

ANS: A

Physical indicators of sexual abuse may include swelling or itching of the genitalia and pain on urination. Other indicators may include bruises, bleeding, or lacerations of the external genitalia, vagina, or anal area. The infant with fetal alcohol syndrome may have microphthalmia or abnormally small eyes or short palpebral fissures, a thin upper lip, and a poorly developed philtrum. Children who have been emotionally abused may exhibit speech disorders, lags in physical development, failure to thrive, or hyperactive and disruptive behaviors. Opiates can cause these behaviors: detachment and apathy, drowsiness, constricted pupils, constipation, slurred speech, and impaired judgment.

DIF: Cognitive Level: Comprehension REF: p. 789

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

18. A nurse is assessing a child with attention-deficit hyperactivity disorder (ADHD). Which manifestation should the nurse not expect to assess?

a.
Talking incessantly
b.
Blurting out the answers to questions before the questions have been completed
c.
Acting withdrawn in social situations
d.
Fidgeting with hands or feet

ANS: C

The child with ADHD tends to be talkative, often interrupting conversations, rather than withdrawn in social situations. Talking excessively is a characteristic of impulsivity/hyperactivity. Blurting out the answers to questions before the questions have been completed is an indication of the impulse control that is often lacking in children with ADHD. The child with ADHD tends to be talkative, often interrupting conversations, rather than withdrawn in social situations.

DIF: Cognitive Level: Analysis REF: p. 778

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

MULTIPLE RESPONSE

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

a.
Bruises in various stages of healing
b.
Bruises over the shins or bony prominences
c.
Burns on the palms of the hands
d.
A fracture of the right wrist from a sports accident
e.
Rib fractures in an infant

ANS: A, C, E

Bruises in various stages of healing and burns on the palms of the hand may be indicative of physical abuse. Rib fractures in an infant are another indicator of physical abuse. Bruises over the shins or bony prominences are seen in children beginning to walk. A fracture of the right wrist can occur as the child begins to participate in sports activities.

DIF: Cognitive Level: Analysis REF: p. 788

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

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

a.
Previous suicide attempt
b.
No previous exposure to violence in the home
c.
Recent loss
d.
Effective social network
e.
History of physical abuse

ANS: A, C, E

The risk of suicide increases if the child has had a previous suicide attempt, a recent loss, or a history of physical abuse. No previous violence in the home or having an effective social network decreases the risk of suicide.

DIF: Cognitive Level: Analysis REF: pp. 776-777

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity