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The behaviors by the bullying child create emotional pain and present the risk for physical pain. Encouraging the victimized child to share feelings about the experience provides the nurse an opportunity to further assess the situation as well as provide support to the child. The nurse should validate the child for reporting the events. Later, school authorities should be notified. School administrators are the most appropriate personnel to deal with the bullying child. The behavior should not be ignored; it will only get worse.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 11-8, 12 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Disobedience b. Hyperactivity c. Impulsivity d. Anxiety

18. Assessment data for a 7-year-old reveals an inability to take turns, blurting out answers to questions before a question is complete, and frequently interrupting others’ conversations. How should the nurse document these behaviors?

ANS: C

These behaviors are most directly related to impulsivity. Hyperactive behaviors are more physical in nature, such as running, pushing, and the inability to sit. Inattention is demonstrated by failure to listen. Defiance is demonstrated by willfully doing what an authority figure has said not to do.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 11-37 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Increased expressiveness in communication with others b. Abilities to identify anxiety and implement self-control strategies c. Improved abilities to participate in cooperative play with other children d. Tolerates social interactions for short periods without disruption or frustration

19. A child diagnosed with ADHD shows hyperactivity, aggression, and impaired play. The health care provider prescribed amphetamine salts (Adderall). The nurse should monitor for which desired behavior?

ANS: C

The goal is improvement in the child’s hyperactivity, aggression, and play. The remaining options are more relevant for a child with intellectual development disorder or an anxiety disorder.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 11-41 to 43

TOP: Nursing Process: Outcomes Identification

MSC: Client Needs: Psychosocial Integrity

20. When group therapy is prescribed as a treatment modality, the nurse would suggest placement of a 9-year-old in a group that uses a. guided imagery. b. talk focused on a specific issue. c. play and talk about a play activity. d. group discussion about selected topics.

ANS: C

Group therapy for young children takes the form of play. For elementary school children, therapy combines play and talk about the activity. For adolescents, group therapy involves more talking.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 11-13, 14, 19 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. A 4-year-old who stuttered for 3 weeks after the birth of a sibling b. A 9-month-old who does not eat vegetables and likes to be rocked c. A 3-month-old who cries after feeding until burped and sucks a thumb d. A 3-year-old who is mute, passive toward adults, and twirls while walking

21. Which child demonstrates behaviors indicative of a neurodevelopmental disorder?

ANS: D

Symptoms consistent with autistic spectrum disorders (ASD) are evident in the correct answer. ASD is one type of neurodevelopmental disorder. The behaviors of the other children are within normal ranges.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 11-32, 33, 61 (Box 11-2) TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. “Perhaps your child was misdiagnosed.” b. “Your observation indicates the medication is effective.” c. “Tics often change frequency or severity. That doesn’t mean they aren’t real.” d. “This finding is unexpected. How have you been administering your child’s medication?”

22. The parent of a child diagnosed with Tourette’s disorder says to the nurse, “I think my child is faking the tics because they come and go.” Which response by the nurse is accurate?

ANS: C

Tics are sudden, rapid, involuntary, repetitive movements or vocalizations characteristic of Tourette’s disorder. They often fluctuate in frequency, severity, and are reduced or absent during sleep.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 11-22, 23

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation

23. When a 5-year-old is disruptive, the nurse says, “You must take a time-out.” The expectation is that the child will a. go to a quiet room until called for the next activity. b. slowly count to 20 before returning to the group activity. c. sit on the edge of the activity until able to regain self-control. d. sit quietly on the lap of a staff member until able to apologize for the behavior.

ANS: C

Time-out is designed so that staff can be consistent in their interventions. Time-out may require going to a designated room or sitting on the periphery of an activity until the child gains self-control and reviews the episode with a staff member. Time-out may not require going to a designated room and does not involve special attention such as holding. Counting to 10 or 20 is not sufficient.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 11-18 TOP: Nursing Process: Implementation eBay: testbanks_and_xanax

MSC: Client Needs: Safe, Effective Care Environment

24. A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child formed a trusting relationship with a shelter volunteer. The child says, “My three friends and I got an A on our school science project.” The nurse can assess that the child a. displays resiliency. b. has a passive temperament. c. is at risk for PTSD. d. uses intellectualization to deal with problems.

ANS: A

Resiliency enables a child to handle the stresses of a difficult childhood. Resilient children can adapt to changes in the environment, take advantage of nurturing relationships with adults other than parents, distance themselves from emotional chaos occurring within the family, learn, and use problem-solving skills.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 11-6, 7

MSC: Client Needs: Psychosocial Integrity

Multiple Response

TOP: Nursing Process: Assessment a. Autism b. Bullying c. Mental retardation d. Autism spectrum disorder e. Intellectual development disorder

1. A nurse prepares to lead a discussion at a community health center regarding children’s health problems. The nurse wants to use current terminology when discussing these issues. Which terms are appropriate for the nurse to use? (Select all that apply.)

ANS: B, D, E

Some dated terminology contributes to the stigma of mental illness and misconceptions about mental illness. It is important for the nurse to use current terminology.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 11-8, 25, 29

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation

2. A nurse prepares the plan of care for a 15-year-old diagnosed with moderate intellectual developmental disorder. What are the highest outcomes that are realistic for this patient? Within 5 years, the patient will (Select all that apply) a. graduate from high school. b. live independently in an apartment. c. independently perform own personal hygiene. d. obtain employment in a local sheltered workshop. e. correctly use public buses to travel in the community.

ANS: C, D, E

Individuals with moderate intellectual developmental disorder progress academically to about the second grade. These people can learn to travel in familiar areas and perform unskilled or semiskilled work. With supervision, the person can function in the community, but independent living is not likely.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 11-25 to 28

TOP: Nursing Process: Outcomes Identification

MSC: Client Needs: Psychosocial Integrity a. Report the finding to the official child protection social services agency. b. Educate all members of the family about potential safety risks in online environments. c. Talk with the parents about parental controls on the children’s communication devices. d. Encourage the family to schedule daily time together without communication devices. e. Obtain the family’s network password and examine online sites family members have visited.

3. At the time of a home visit, the nurse notices that each parent and child in a family has his or her own personal online communication device. Each member of the family is in a different area of the home. Which nursing actions are appropriate? (Select all that apply.)

ANS: B, C, D

The nurse’s focus is safety, including online environments. Education and awareness-based approaches are indicated to reduce the risks of potentially harmful behavior, including risks associated with cyberbullying. Parental controls on the children’s devices will support safe Internet use. Family time together will promote healthy bonding and a sense of security among members. There is no evidence of danger to the children, so a report to child protective agency is unnecessary. It would be inappropriate to seek the family’s network password and an invasion of privacy to inspect sites family members have visited.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 11-8, 45, 61 (Box 11-2) TOP: Nursing Process: Assessment

MSC: Client Needs: Safe, Effective Care Environment a. Having a mother diagnosed with schizophrenia b. Being the oldest child in a family c. Living with an alcoholic parent d. Being an only child e. Living in an urban community

4. Which assessment findings present familial risks for a child to develop a psychiatric disorder? (Select all that apply.)

ANS: A, C

Familial risk factors that correlate with child psychiatric disorders include severe marital discord, low socioeconomic status, large families and overcrowding, parental criminality, maternal psychiatric disorders, and foster-care placement. Having a parent with a substance abuse problem increases the risk of marital discord. A family history of schizophrenia presents a genetic risk. Being in a middle-income family, living in an urban community, and being an only or oldest child do not represent adversity.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 11-6, 7

TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity