Correct Answer: 4

Rationale 1: Separation anxiety disorder involves a developmentally inappropriate and excessive anxiety over separation from home or from attachment figures and may appear after a stressful life event such as the death of a pet. This childs dog may be viewed as an attachment figure, thus placing this child at risk for a separation anxiety disorder. Risk factors for conduct disorder are related to difficulties with parentchild interactions. Children with elimination problems may have psychosocial risk factors; however, the best response in this situation is to develop interactions to prevent separation anxiety disorder, which can be directly linked to the death of the childs companion. Angoraphobia is the fear of soft sweaters and rabbits and is not related to this situation.

Rationale 2: Separation anxiety disorder involves a developmentally inappropriate and excessive anxiety over separation from home or from attachment figures and may appear after a stressful life event such as the death of a pet. This childs dog may be viewed as an attachment figure, thus placing this child at risk for a separation anxiety disorder. Risk factors for conduct disorder are related to difficulties with parentchild interactions. Children with elimination problems may have psychosocial risk factors; however, the best response in this situation is to develop interactions to prevent separation anxiety disorder, which can be directly linked to the death of the childs companion. Angoraphobia is the fear of soft sweaters and rabbits and is not related to this situation.

Rationale 3: Separation anxiety disorder involves a developmentally inappropriate and excessive anxiety over separation from home or from attachment figures and may appear after a stressful life event such as the death of a pet. This childs dog may be viewed as an attachment figure, thus placing this child at risk for a separation anxiety disorder. Risk factors for conduct disorder are related to difficulties with parentchild interactions. Children with elimination problems may have psychosocial risk factors; however, the best response in this situation is to develop interactions to prevent separation anxiety disorder, which can be directly linked to the death of the childs companion. Angoraphobia is the fear of soft sweaters and rabbits and is not related to this situation.

Rationale 4: Separation anxiety disorder involves a developmentally inappropriate and excessive anxiety over separation from home or from attachment figures and may appear after a stressful life event such as the death of a pet. This childs dog may be viewed as an attachment figure, thus placing this child at risk for a separation anxiety disorder. Risk factors for conduct disorder are related to difficulties with parentchild interactions. Children with elimination problems may have psychosocial risk factors; however, the best response in this situation is to develop interactions to prevent separation anxiety disorder, which can be directly linked to the death of the childs companion. Angoraphobia is the fear of soft sweaters and rabbits and is not related to this situation.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: Incorporate an understanding of the potential risk factors for childhood mental illness into working with children in community settings.

Question 13

Type: MCSA

A mother questions why it is important to list when her child sat up, began crawling, started walking, and was potty trained as she is bringing the toddler in because the child screams at night. The nurse explains to the mother that:

1. It is not normal for a young child to scream at night.

2. Children who scream at night have more difficulty with problem solving.

3. Children with mental disorders have difficulty with elimination at night.

4. A developmental history is part of assessing well-being of a child.

Correct Answer: 4

Rationale 1: The basics of an effective assessment include gathering cultural and developmental information, eliciting a history from the parents, and undertaking a clinical assessment of the child. These are developmental milestones. It is important to obtain information about the child to assist in identifying developmental progress. Night terrors are common in younger children and tend to happen when the child is in a deep sleep. The statements that children with mental disorders have difficulty with elimination at night and children who scream at night have more difficulty with problem-solving are incorrect.

Rationale 2: The basics of an effective assessment include gathering cultural and developmental information, eliciting a history from the parents, and undertaking a clinical assessment of the child. These are developmental milestones. It is important to obtain information about the child to assist in identifying developmental progress. Night terrors are common in younger children and tend to happen when the child is in a deep sleep. The statements that children with mental disorders have difficulty with elimination at night and children who scream at night have more difficulty with problem-solving are incorrect.

Rationale 3: The basics of an effective assessment include gathering cultural and developmental information, eliciting a history from the parents, and undertaking a clinical assessment of the child. These are developmental milestones. It is important to obtain information about the child to assist in identifying developmental progress. Night terrors are common in younger children and tend to happen when the child is in a deep sleep. The statements that children with mental disorders have difficulty with elimination at night and children who scream at night have more difficulty with problem-solving are incorrect.

Rationale 4: The basics of an effective assessment include gathering cultural and developmental information, eliciting a history from the parents, and undertaking a clinical assessment of the child. These are developmental milestones. It is important to obtain information about the child to assist in identifying developmental progress. Night terrors are common in younger children and tend to happen when the child is in a deep sleep. The statements that children with mental disorders have difficulty with elimination at night and children who scream at night have more difficulty with problem-solving are incorrect.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Modify a care plan according to the signs and symptoms associated with common childrens psychiatric disorders.

Question 14

Type: MCSA

Which of the following behaviors observed by the nurse will be important to disclose to the teacher of a child with a stereotypic movement disorder?

1. An episode of self-mutilation

2. Depression that results from feelings of inadequacy

3. Tendency to be hypoactive

4. Flexibility and ability to contribute to learning

Correct Answer: 1

Rationale 1: Some children with a spectrum disorder have many associated behavioral problems such as hyperactivity, aggressiveness, self-injurious behaviors such as head banging, and temper tantrums. This is important and relevant to discuss with the childs teacher who is a member of the treatment team. Problems with socialization and communication difficulties are also common, evidenced by deficits in spontaneous, imaginative play. Stereotypic movement disorder involves repetitive nonfunctional motor behavior (i.e., hand waving, self-biting, body rocking, or head banging) that interferes with normal activity or risks self-inflicted bodily injury. The behavior lasts 4 weeks or longer. These behaviors are seemingly driven and protective measures are usually needed so that medical treatment will not be necessary. These children will have difficulty adapting to change, so they will have great difficulty, if able at all, to be flexible or contribute to their learning. The childs tendency would be toward hyperactivity rather than hypoactivity.

Rationale 2: Some children with a spectrum disorder have many associated behavioral problems such as hyperactivity, aggressiveness, self-injurious behaviors such as head banging, and temper tantrums. This is important and relevant to discuss with the childs teacher who is a member of the treatment team. Problems with socialization and communication difficulties are also common, evidenced by deficits in spontaneous, imaginative play. Stereotypic movement disorder involves repetitive nonfunctional motor behavior (i.e., hand waving, self-biting, body rocking, or head banging) that interferes with normal activity or risks self-inflicted bodily injury. The behavior lasts 4 weeks or longer. These behaviors are seemingly driven and protective measures are usually needed so that medical treatment will not be necessary. These children will have difficulty adapting to change, so they will have great difficulty, if able at all, to be flexible or contribute to their learning. The childs tendency would be toward hyperactivity rather than hypoactivity.

Rationale 3: Some children with a spectrum disorder have many associated behavioral problems such as hyperactivity, aggressiveness, self-injurious behaviors such as head banging, and temper tantrums. This is important and relevant to discuss with the childs teacher who is a member of the treatment team. Problems with socialization and communication difficulties are also common, evidenced by deficits in spontaneous, imaginative play. Stereotypic movement disorder involves repetitive nonfunctional motor behavior (i.e., hand waving, self-biting, body rocking, or head banging) that interferes with normal activity or risks self-inflicted bodily injury. The behavior lasts 4 weeks or longer. These behaviors are seemingly driven and protective measures are usually needed so that medical treatment will not be necessary. These children will have difficulty adapting to change, so they will have great difficulty, if able at all, to be flexible or contribute to their learning. The childs tendency would be toward hyperactivity rather than hypoactivity.

Rationale 4: Some children with a spectrum disorder have many associated behavioral problems such as hyperactivity, aggressiveness, self-injurious behaviors such as head banging, and temper tantrums. This is important and relevant to discuss with the childs teacher who is a member of the treatment team. Problems with socialization and communication difficulties are also common, evidenced by deficits in spontaneous, imaginative play. Stereotypic movement disorder involves repetitive nonfunctional motor behavior (i.e., hand waving, self-biting, body rocking, or head banging) that interferes with normal activity or risks self-inflicted bodily injury. The behavior lasts 4 weeks or longer. These behaviors are seemingly driven and protective measures are usually needed so that medical treatment will not be necessary. These children will have difficulty adapting to change, so they will have great difficulty, if able at all, to be flexible or contribute to their learning. The childs tendency would be toward hyperactivity rather than hypoactivity.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Modify a care plan according to the signs and symptoms associated with common childrens psychiatric disorders.

Question 15

Type: MCSA

The school nurse is observing a young child who has episodes of rage toward peers during recess and at lunchtime. The advantage of conducting an assessment in this environment is:

1. This will assist in identifying the bullies who trigger the explosive episodes.

2. This provides an opportunity to collect data in the event that other children are injured and legal documentation is needed.

3. To provide data for the parents who are in denial about the problem.

4. This provides a picture of problems and strengths in a realistic context.

Correct Answer: 4

Rationale 1: Play has been described as the work of children. Observing the child interacting with peers during recess and lunchtime enables the nurse to observe the child duringunstructured play, which is part of the mental status assessment. The nurse is not observing the child due to a potential lawsuit, to help identify bullies, or to provide data for the parents who are in denial, but as part of a nursing assessment.

Rationale 2: Play has been described as the work of children. Observing the child interacting with peers during recess and lunchtime enables the nurse to observe the child during unstructured play, which is part of the mental status assessment. The nurse is not observing the child due to a potential lawsuit, to help identify bullies, or to provide data for the parents who are in denial, but as part of a nursing assessment.

Rationale 3: Play has been described as the work of children. Observing the child interacting with peers during recess and lunchtime enables the nurse to observe the child duringunstructured play, which is part of the mental status assessment. The nurse is not observing the child due to a potential lawsuit, to help identify bullies, or to provide data for the parents who are in denial, but as part of a nursing assessment.

Rationale 4: Play has been described as the work of children. Observing the child interacting with peers during recess and lunchtime enables the nurse to observe the child during unstructured play, which is part of the mental status assessment. The nurse is not observing the child due to a potential lawsuit, to help identify bullies, or to provide data for the parents who are in denial, but as part of a nursing assessment.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Modify a care plan according to the signs and symptoms associated with common childrens psychiatric disorders.

Question 16

Type: MCSA

The nurse is assessing a depressed child who was referred by the elementary school nurse. What is the best approach to use when assessing the childs socialization?

1. Tell me about the friends you enjoy being with.

2. So you spend a lot of time with your friends?

3. You seem like a person who would have a lot of friends.

4. How many friends do you have at school?

Correct Answer: 1

Rationale 1: The nurse is using therapeutic communication and encouraging the client to talk about a positive aspect of life. You seem like a person who would have a lot of friends, is a judgmental observation that may also be viewed as a stereotypical comment. The question How many friends do you have at school? can be perceived as probing and intrusive, which is nontherapeutic. So you spend a lot of time with your friends? invites a yes or no response and does not facilitate exploring the childs feelings about the friends.

Rationale 2: The nurse is using therapeutic communication and encouraging the client to talk about a positive aspect of life. You seem like a person who would have a lot of friends, is a judgmental observation that may also be viewed as a stereotypical comment. The question How many friends do you have at school? can be perceived as probing and intrusive, which is nontherapeutic. So you spend a lot of time with your friends? invites a yes or no response and does not facilitate exploring the childs feelings about the friends.

Rationale 3: The nurse is using therapeutic communication and encouraging the client to talk about a positive aspect of life. You seem like a person who would have a lot of friends, is a judgmental observation that may also be viewed as a stereotypical comment. The question How many friends do you have at school? can be perceived as probing and intrusive, which is nontherapeutic. So you spend a lot of time with your friends? invites a yes or no response and does not facilitate exploring the childs feelings about the friends.

Rationale 4: The nurse is using therapeutic communication and encouraging the client to talk about a positive aspect of life. You seem like a person who would have a lot of friends, is a judgmental observation that may also be viewed as a stereotypical comment. The question How many friends do you have at school? can be perceived as probing and intrusive, which is nontherapeutic. So you spend a lot of time with your friends? invites a yes or no response and does not facilitate exploring the childs feelings about the friends.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Conduct an assessment of a child with a mental health problem.

Question 17

Type: MCSA

The nurse is assessing a child diagnosed with conduct disorder. Which would be the most appropriate question to ask the parents?

1. Does your child have a history of cruelty to other people and animals?

2. Does your child unconsciously direct feelings and desires from other relationships toward others?

3. Does your child seem to be reassured by your presence?

4. Does your child readily seek out caregivers in times of stress?

Correct Answer: 1

Rationale 1: Characteristics of conduct disorder often manifest in behaviors that show aggression toward people and animals; these symptoms may appear as early as 5 or 6 years of age, but occur more typically in later childhood or early adolescence. Transference is a process whereby the child unconsciously directs feelings and desires from other relationships in life onto the therapist. A child who feels secure will readily seek out caregivers in times of stress and is reassured by the caregivers presence.

Rationale 2: Characteristics of conduct disorder often manifest in behaviors that show aggression toward people and animals; these symptoms may appear as early as 5 or 6 years of age, but occur more typically in later childhood or early adolescence. Transference is a process whereby the child unconsciously directs feelings and desires from other relationships in life onto the therapist. A child who feels secure will readily seek out caregivers in times of stress and is reassured by the caregivers presence.

Rationale 3: Characteristics of conduct disorder often manifest in behaviors that show aggression toward people and animals; these symptoms may appear as early as 5 or 6 years of age, but occur more typically in later childhood or early adolescence. Transference is a process whereby the child unconsciously directs feelings and desires from other relationships in life onto the therapist. A child who feels secure will readily seek out caregivers in times of stress and is reassured by the caregivers presence.

Rationale 4: Characteristics of conduct disorder often manifest in behaviors that show aggression toward people and animals; these symptoms may appear as early as 5 or 6 years of age, but occur more typically in later childhood or early adolescence. Transference is a process whereby the child unconsciously directs feelings and desires from other relationships in life onto the therapist. A child who feels secure will readily seek out caregivers in times of stress and is reassured by the caregivers presence.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Conduct an assessment of a child with a mental health problem.

Question 18

Type: MCSA

When planning a new childrens mental health clinic, the nurse understands the importance of including a play area. Play and toys are used to assess children with suspected mental disorders because:

1. Children do not usually relate to adults.

2. Children express themselves through play.

3. Only toys that are developmentally appropriate and specific to the childs biological age are used.

4. Play enables the nurse to assess cognitive ability.

Correct Answer: 2

Rationale 1: A mental status exam on a child consists of both a semi-structured interview and an unstructured play session with the child. Observing a child at play can also provide invaluable information about motor behavior, thought content, affect, and impulse control. There is a general belief that toys with ambiguous meaning and diverse uses foster symbolic play more effectively because they allow the child to project his or her own identity and function onto the toys. The children may or may not relate to adults, but that is not the reason for including the play area. Cognitive ability is only one of the areas of assessment, and not the overall reason for including the play area. Toys may or may not be specific to the childs biological age.

Rationale 2: A mental status exam on a child consists of both a semi-structured interview and an unstructured play session with the child. Observing a child at play can also provide invaluable information about motor behavior, thought content, affect, and impulse control. There is a general belief that toys with ambiguous meaning and diverse uses foster symbolic play more effectively because they allow the child to project his or her own identity and function onto the toys. The children may or may not relate to adults, but that is not the reason for including the play area. Cognitive ability is only one of the areas of assessment, and not the overall reason for including the play area. Toys may or may not be specific to the childs biological age.

Rationale 3: A mental status exam on a child consists of both a semi-structured interview and an unstructured play session with the child. Observing a child at play can also provide invaluable information about motor behavior, thought content, affect, and impulse control. There is a general belief that toys with ambiguous meaning and diverse uses foster symbolic play more effectively because they allow the child to project his or her own identity and function onto the toys. The children may or may not relate to adults, but that is not the reason for including the play area. Cognitive ability is only one of the areas of assessment, and not the overall reason for including the play area. Toys may or may not be specific to the childs biological age.

Rationale 4: A mental status exam on a child consists of both a semi-structured interview and an unstructured play session with the child. Observing a child at play can also provide invaluable information about motor behavior, thought content, affect, and impulse control. There is a general belief that toys with ambiguous meaning and diverse uses foster symbolic play more effectively because they allow the child to project his or her own identity and function onto the toys. The children may or may not relate to adults, but that is not the reason for including the play area. Cognitive ability is only one of the areas of assessment, and not the overall reason for including the play area. Toys may or may not be specific to the childs biological age.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub: