Chapter 33: The Child with an Emotional or Behavioral Condition Nursing School Test Banks

Chapter 33: The Child with an Emotional or Behavioral Condition

MULTIPLE CHOICE

1. A parent asks the nurse to describe what is meant by a learning disability. Which is the nurses most helpful response?
a. A child may have difficulty with perception, language, comprehension, or memory.
b. It is characterized by inattention, impulsiveness, and hyperactivity.
c. The childs intellectual ability limits his learning.
d. The child has difficulty learning because of brain damage.
ANS: A
Learning disability is an educational term. Children with learning disabilities may have average to above-average intelligence, but they may experience difficulties in perception, language, comprehension, and conceptualization.

DIF: Cognitive Level: Comprehension REF: Page 749 OBJ: N/A
TOP: Learning Disability KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. What would be the appropriate response to an adolescent who states, This has been the worst day of my life?
a. You should focus your mind on positive thoughts.
b. Everybody has a bad day now and then.
c. Youre young. What could be so terrible?
d. Tell me about the worst day of your life.
ANS: D
The nurse establishes a rapport with the adolescent by acknowledging his or her feelings and giving the adolescent full attention.

DIF: Cognitive Level: Application REF: Page 754, Nursing Tip
OBJ: 6 TOP: Suicide KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

3. The nurse asks, Do your parents drink every day? The adolescent suddenly shouts, Im not going to talk about that! Its none of your business, anyway! Leave me alone! How does the nurse interpret the adolescents behavior?
a. The adolescent is acting out and needs to be brought under control so the conference can continue.
b. The adolescent is trying to shift the focus of the conference away from himself, and the nurse needs to refocus.
c. The adolescent is demonstrating that this problem requires the assistance of a psychiatrist.
d. The adolescent is responding to the discrediting of his parents, which causes anxiety.
ANS: D
Discrediting parents threatens the childs security and creates anxiety.

DIF: Cognitive Level: Analysis REF: Page 757-758
OBJ: 10 TOP: Children of Alcoholics
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

4. The nurse is answering phone calls at a local suicide prevention hotline. Which statement would be recognized as the greatest risk of suicide?
a. I just needed to talk to someone to keep myself from thinking silly thoughts about killing myself.
b. My parents arent home and wont be back for 4 hours. That should be enough time for the pills to work. Ive got a hundred of them.
c. My dad will be home first, so hell find me. So I think Ill use his gun. I hope he didnt lock the cabinet.
d. My girlfriend is here with me. She told me to call because I was talking crazy about killing myself.
ANS: B
The risk of death increases when there is a definite plan of action, the means are readily available, and the person has few resources for help and support.

DIF: Cognitive Level: Analysis REF: Page 752-753, NCP 33-1
OBJ: 6 TOP: Suicide KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

5. A 15-year-old boy was previously active in a band and saved money to buy a special guitar. What would a nurse assess as an early sign of depression in this boy?
a. He gives up the band to spend time with his girlfriend.
b. He spends all of his time at the library studying to qualify for the honor society.
c. He gives his guitar away and spends his time listening to music in his room.
d. He withdraws all of his money out of the bank to buy an expensive leather jacket.
ANS: C
A major depression is characterized by a prolonged behavioral change from baseline that interferes with school, family life, and age-specific activities, frequently signaled by giving prized possessions away.

DIF: Cognitive Level: Analysis REF: Page 751-752
OBJ: 6 TOP: Depression KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

6. A mother is concerned because her adolescent son is always in trouble for fighting at school and always seems to be angry. She mentions that her husband drinks a bit. Which understanding will guide the nurses response?
a. The boy is displaying antisocial behavior and should be evaluated for mental illness.
b. The boy is displaying one of the typical defense patterns of children of alcoholics and should receive immediate treatment.
c. The mother is displaying her own anger with her husbands drinking, and she needs immediate intervention.
d. The boy is only one member of the family affected by alcoholism, and all members should receive immediate intervention.
ANS: D
Early recognition of and intervention for children of alcoholics are paramount. This adolescent is using the coping pattern of acting-out behaviors to deal with the family situation.

DIF: Cognitive Level: Comprehension REF: Page 757-758
OBJ: 10 TOP: Children of Alcoholics
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

7. What is the most appropriate classroom intervention for a child with attention deficit hyperactivity disorder (ADHD) for the school nurse to suggest?
a. Seat the child in the back of the room to prevent distractions for other children.
b. Pair the child with a student buddy to offer reminders to pay attention.
c. Divide work assignments into shorter periods with breaks in between.
d. Separate the child from others to increase his focus on schoolwork.
ANS: C
The child with ADHD needs breaks between periods of work and study.

DIF: Cognitive Level: Application REF: Page 750, Health Promotion Box
OBJ: 12 TOP: Attention Deficit Hyperactivity Disorder
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

8. How does the nurse describe a person who is bulimic?
a. Severely underweight
b. Alternates binge eating with purging
c. Introverted perfectionist
d. Has extremely close family relationships
ANS: B
Bulimia is characterized by alternating binge eating and purge behavior.

DIF: Cognitive Level: Comprehension REF: Page 751-752
OBJ: 13 TOP: Bulimia KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

9. A 14-year-old girl with obsessive-compulsive disorder (OCD) tells the nurse other adolescents tease her because she washes her hands many times during the school day. For what does this disorder put the adolescent at greater risk?
a. Anorexia nervosa
b. Depression
c. ADHD
d. A learning disability
ANS: B
OCD is related to depression and other psychiatric disorders. Suicidal behavior is a high risk for adolescents with OCD.

DIF: Cognitive Level: Comprehension REF: Page 748-749
OBJ: 5 TOP: Obsessive-Compulsive Disorder
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

10. Which statement made by a parent of an adolescent with anorexia nervosa indicates an understanding of this condition?
a. There really isnt anything to worry about. Dont they say you can never be too thin?
b. My daughter just doesnt have much of an appetite.
c. She is just trying to punish me for divorcing her father.
d. She seems to see herself as fat, even though her weight is below normal.
ANS: D
Individuals with anorexia nervosa have a disturbed body image, which this parent correctly recognizes.

DIF: Cognitive Level: Comprehension REF: Page 750, Figure 33-3
OBJ: 13 TOP: Anorexia Nervosa
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

11. What is an appropriate nursing intervention for a hospitalized child who is autistic?
a. Place the child in a location where she can watch all of the activity on the unit.
b. Use the childs chronological age as a guide for communication.
c. Keep the childs room free of toys or objects that she might want to take home with her.
d. Organize care to provide as few disruptions to the routine as possible.
ANS: D
During hospitalization, the nurse should provide a highly structured environment with few distractions for a child who is autistic.

DIF: Cognitive Level: Application REF: Page 748 OBJ: 4
TOP: Autism KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

12. A nurse is planning to speak with a parent support group about childhood autism. What will the nurse include?
a. Significant signs of the disorder manifest by 1 year of age.
b. The earliest signs of autism are impulsivity and overactivity.
c. Autism is usually diagnosed when the child goes to elementary school.
d. Medications can cure childhood autism.
ANS: A
Failure to use eye contact and look at others, poor attention span, and poor orienting to ones name are significant signs of dysfunction by 1 year of age.

DIF: Cognitive Level: Comprehension REF: Page 748 OBJ: 4
TOP: Autism KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

13. An adolescent is brought to the emergency department after an automobile accident. When the nurse approaches the adolescent, he becomes combative. The nurse notes his speech is slurred and his gait is ataxic. What does the nurse suspect the adolescent has used?
a. Alcohol
b. Cocaine
c. Amphetamines
d. PCP
ANS: A
Behavioral signs of alcohol ingestion include slurred speech, short attention span, drowsiness, combativeness, and violence.

DIF: Cognitive Level: Analysis REF: Page 755, Table 33-1
OBJ: 8 TOP: Substance Abuse
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

14. When the nurse is collecting a nursing history, an adolescent states that she has tried speed. For what does the nurse recognize this as the street name?
a. Barbiturates
b. Cocaine
c. Methamphetamine
d. Marijuana
ANS: C
Speed is the street name for methamphetamine.

DIF: Cognitive Level: Knowledge REF: Page 755, Table 33-2
OBJ: 8 TOP: Substance Abuse
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

15. How would the nurse identify a member of the child guidance team who is a medical doctor with special training in psychoanalytic theory?
a. Psychiatrist
b. Psychoanalyst
c. Psychologist
d. Counselor
ANS: A
The psychiatrist is a medical doctor; the psychoanalyst may be a medical doctor or a psychologist. The psychologist is not a medical doctor, and neither is the counselor.

DIF: Cognitive Level: Knowledge REF: Page 747 OBJ: 2
TOP: Psychoanalytic Professional KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

16. A young child on the pediatric unit cannot express himself well. What therapeutic intervention might the nurse implement that allows children to act out their feelings?
a. Art therapy
b. Play therapy
c. Music therapy
d. Bibliotherapy
ANS: B
Play therapy allows a young child to act out with dolls or figures concerns that the child may be unable to adequately express verbally.

DIF: Cognitive Level: Comprehension REF: Page 747 OBJ: 5
TOP: Play Therapy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

17. The nurse explains that use of stimulants will decrease hyperactivity in the autistic child. What is a negative aspect of stimulants?
a. Sedating the child
b. Impairing cognition
c. Causing hypotension
d. Creating fluid retention
ANS: B
Stimulants that decrease the hyperactivity in the autistic child also impair cognition and may increase the potential of self-injuring behavior.

DIF: Cognitive Level: Comprehension REF: Page 748 OBJ: 4
TOP: Autism KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

18. A 9-year-old has been admitted to the hospital after huffing lighter fluid and is in a high euphoric state. For what should the nurse assess?
a. Depressed respirations
b. Severe vomiting
c. Frightening hallucinations
d. Elevation of temperature
ANS: A
Inhaling hydrocarbons depresses the central nervous system, including respiratory rate and general sensorium.

DIF: Cognitive Level: Application REF: Page 756 OBJ: 8
TOP: Substance Abuse KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Reduction of Risk

19. The pediatric nurse listens to a 9-year-old child read to his 6-year-old roommate. What action by 9-year-old child leads the nurse to question possible dyslexia?
a. Becomes hyperactive and ceases to read
b. Reads the word dog as God
c. Makes up a story rather than reading the text
d. Stutters as he reads
ANS: B
Dyslexics often transpose a word as they read; for example, the word is dog, but it appears to the dyslexic child as the word God.

DIF: Cognitive Level: Comprehension REF: Page 749 OBJ: N/A
TOP: Dyslexia KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

20. How is a gateway substance defined?
a. Recreational drug used occasionally
b. Nonaddictive drug used daily
c. Drug used to wean from stronger drugs
d. Substance that can lead to use of stronger drugs
ANS: D
A gateway drug is a substance that creates a high that can lead to the use of stronger drugs.

DIF: Cognitive Level: Knowledge REF: Page 754, Nursing Tip
OBJ: 8 TOP: Gateway Drugs
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

21. Which substance puts a person at the greatest risk for HIV and hepatitis B?
a. Alcohol
b. Opiates
c. Cocaine
d. Marijuana
ANS: B
The use of opiates coupled with sharing needles put the user at risk for HIV and hepatitis B.

DIF: Cognitive Level: Comprehension REF: Page 755, Table 33-1
OBJ: 8 TOP: Opiate Use KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

22. What role has the child of an alcoholic assumed if he tries to do everything perfectly?
a. Perfect child
b. Super coper
c. Flight
d. Helper
ANS: B
Of the four roles for the child of the alcoholic, the super coper is one who tries to do everything perfectly and feels overly responsible. The perfect child is the child who tries to earn love by never causing any trouble.

DIF: Cognitive Level: Comprehension REF: Page 757-758
OBJ: 10 TOP: Child of an Alcoholic
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

MULTIPLE RESPONSE

23. The nurse working with children from dysfunctional families must be prepared to address what associated problem(s)? (Select all that apply.)
a. Lack of trust
b. Acting out
c. Exaggerated self-confidence
d. Blaming others for problems
e. Depression
ANS: A, B, E
Children from dysfunctional families exhibit lack of trust, act out, and show signs of depression.

DIF: Cognitive Level: Comprehension REF: Page 747 OBJ: 3
TOP: Dysfunctional Families KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

24. The nurse counsels parents that the early school years create nervous tension in the child manifested by which abnormal behavior(s)? (Select all that apply.)
a. Masturbation
b. Food fads
c. Stuttering
d. Aggressive behavior
e. Nonnutritive sucking
ANS: C, D, E
Stuttering, aggressive behavior, and finger or thumb sucking that appear suddenly with no previous history are a clue to increased nervous tension in the young school-age child. Masturbation and food fads are normal behavioral phenomena for the early school-age child.

DIF: Cognitive Level: Comprehension REF: Page 748 OBJ: 3
TOP: Nervous Tension KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

25. The nurse states that the members of a mental health team for child guidance include which member(s)? (Select all that apply.)
a. Psychiatrist
b. Pediatrician
c. Psychologist
d. Dietitian
e. Social worker
ANS: A, B, C, E
The traditional members of the child guidance team are the psychiatrist, pediatrician, psychologist, and social worker. The dietitian is not usually on the treatment team.

DIF: Cognitive Level: Knowledge REF: Page 747 OBJ: 2
TOP: Members of the Child Guidance Team
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

26. The school nurse cautions a group of parents about the prevalence of children who get high by inhaling hydrocarbons and fluorocarbons. Which products contain these substances? (Select all that apply.)
a. Glue
b. Chlorine
c. Cleaning fluid
d. Copy machine toner
e. Aerosol sprays
ANS: A, C, E
Although there are many products that could be inhaled, the most frequently used products are glue, cleaning fluid, aerosol sprays, Freon, shoe polish, and gasoline products.

DIF: Cognitive Level: Knowledge REF: Page 755, Table 33-1
OBJ: 8 TOP: Inhaling Hydrocarbons
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

27. The nurse is planning the care of an adolescent with anorexia nervosa. What characteristic(s) cause this disorder? (Select all that apply.)
a. Discomfort relative to emerging sexuality
b. Fear of intimacy
c. Pervasive high self-esteem
d. Egocentricity
e. Inability to meet developmental needs
ANS: A, B, D, E
All options except pervasive high self-esteem are considered to be a cause of anorexia nervosa. Pervasive low self-esteem also is considered a cause of anorexia nervosa.

DIF: Cognitive Level: Comprehension REF: Page 750 OBJ: 13
TOP: Anorexia Nervosa KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

28. The nurse is assessing a 16-year-old female for characteristics of anorexia nervosa. Which assessment finding(s) would lead the nurse to suspect the possibility of this diagnosis? (Select all that apply.)
a. Amenorrhea
b. Severe weight loss
c. Oily skin
d. Hypertension
e. Lanugo on back
ANS: A, B, E
The primary symptom of anorexia nervosa is severe weight loss. Adolescents who wish to be fashion models or actresses or who participate in sports, dance, or gymnastics activities may be at risk for developing an eating disorder. On physical examination, some of the following conditions may be evident: dry skin, amenorrhea, lanugo hair over the back and extremities, cold intolerance, low blood pressure, abdominal pain, and constipation.

DIF: Cognitive Level: Comprehension REF: Page 750 OBJ: 13
TOP: Anorexia Nervosa KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

29. A nurse is hired to work in a psychiatric facility on a unit specializing in obsessive compulsive disorders (OCD). Which diagnoses might the nurse expect to encounter? (Select all that apply.)
a. Trichotillomania
b. Hoarding disorder
c. Excoriation disorder
d. Body dysmorphic disorder
e. Oppositional defiant disorder
ANS: A, B, C, D
Oppositional defiant disorder is described as an ongoing pattern of anger-guided disobedience, a hostile or defiant response to authority and is not considered a form of OCD.

DIF: Cognitive Level: Knowledge REF: Page 749 OBJ: 5
TOP: Obsessive Compulsive Disorder KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

30. A child is diagnosed with attention deficit hyperactivity disorder (ADHD). Which characteristics would the nurse assess in this child? (Select all that apply.)
a. Social anxiety
b. Impulsivity
c. Hyperactivity
d. Distractability
e. Inattention
ANS: B, C, D, E
ADHD is characterized by inattention, hyperactivity, impulsivity, and distractibility.

DIF: Cognitive Level: Knowledge REF: Page 749 OBJ: 11
TOP: Attention Deficit Hyperactivity Disorder
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

COMPLETION

31. The nurse documents that every time the child is directed to discuss the relationship with her brother, she complains of shortness of breath and begins to have asthma-like symptoms. The nurse assesses this behavior as a(n) _________________ reaction.

ANS:
psychosomatic

A psychosomatic reaction is one in which a dysfunction of the body has an emotional or mental cause.

DIF: Cognitive Level: Comprehension REF: Page 748 OBJ: 1
TOP: Psychosomatic Reaction KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

32. The nurse assists with the intervention of ____________ therapy, which provides a physical and social environment that is stable and therapeutic.

ANS:
milieu

Milieu therapy is a modality of treatment offered to troubled children, in which they are placed in an environment that is stable and therapeutic so that their problems might be better expressed or identified.

DIF: Cognitive Level: Knowledge REF: Page 747 OBJ: 1
TOP: Milieu Therapy KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

33. Early childhood experiences are critical to personality formation. Situations that disrupt family patterns can have a lasting impact on the child. These families are known as _____________ and can make children feel negatively about themselves and the world.

ANS:
dysfunctional

Early childhood experiences are critical to personality formation. Situations that disrupt family patterns can have a lasting impact on the child. Children who come from these dysfunctional families may experience any of the following: failure to develop a sense of trust (in their caregivers and environment), excessive fears, misdirected anger manifested as behavioral problems, depression, low self-esteem, lack of confidence, and feelings of lack of control over themselves and their environment.

Cognitive Level: Knowledge

DIF: Cognitive Level: Knowledge REF: Page 747 OBJ: 1 |3
TOP: Suicide KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Psychosocial Integrity: Therapeutic Environment

34. Put the 5 steps of the SAFE-T program in the correct order. Put a comma and space between each answer choice (a, b, c, d, etc.)

a. Determine risk level
b. Document and follow up
c. Identify risk
d. Identify protective factors
e. Suicide inquiry

ANS:
C, D, E, A, B

The order of the SAFE-T program is to first identify risk (warning signs); second,
identify protective factors (coping strategies; support persons); third, suicide inquiry (identify plans); fourth, determine risk level (interventions); and last, to document and follow up.

DIF: Cognitive Level: Comprehension REF: Page 754 OBJ: 7
TOP: Suicide
KEY: Nursing Process Step: Data Collection | Nursing Process Step: Intervention | Nursing Process Step: Evaluation MSC: NCLEX: Psychosocial Integrity: Crisis Intervention

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