PEDS: Chapter 53: Psychosocial Problems in Children and Families

Which sign or symptom is likely to be manifested by an adolescent with a depressive

disorder?

a. Abuse of alcohol

b. Impulsivity and distractibility

c. Carelessness and inattention to details

d. Refusal to leave the house

ANS: A

Feedback

A Depression often manifests in conjunction with substance abuse, so children who

abuse substances should be evaluated for depression as well.

B Impulsivity and distractibility are manifestations of

attention-deficit/hyperactivity disorder (ADHD).

C A diminished ability to think or concentrate, carelessness, and inattention to

details is a clinical manifestation of ADHD.

D A refusal to leave the house, even to play with friends, is characteristic of

separation anxiety disorder.

Which statement about suicide is correct?

a. Children younger than 10 years of age do not attempt suicide.

b. Suicide risk decreases with age.

c. Suicide is usually an isolated event in a school community.

d. The prevalence of suicide attempts is higher among males.

ANS: A

Feedback

A Suicide by children under the age of 10 is uncommon.

B The risk of suicide increases with age.

C It is common for suicide to occur in a cluster within a community (e.g., schools).

D Males have a 4% rate of suicide attempts compared to 8% in females; however,

males are more likely to die after a suicide attempt.

The best response for the nurse to make to an adolescent who states, "I am very sad. I wish

I was not alive." is

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

Feedback

A This is a judgmental response that ignores the adolescent's obvious statement

indicating a need for professional help.

B This is a judgmental response that could increase the adolescent's sense of

isolation and rejection.

C The parents should be made aware of an adolescent's precarious mental state;

however, this response does not address the adolescent's statement.

D This response acknowledges the adolescent's suicide gesture and further assesses

the adolescent's condition.

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 perception of body image

ANS: D

Feedback

A The treatment of eating disorders is initially focused on reestablishing

physiologic homeostasis.

B Once body systems are stabilized, the next goal of treatment for eating disorders

is maintaining adequate caloric intake.

C 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.

D The focus of treatment in individual therapy for an eating disorder involves

restructuring cognitive perceptions about the individual's body image.

A parent of a child with an anxiety disorder states, "I don't know how my child developed

this problem." On what information should the nurse base a response?

a. Genetic factors, hormonal imbalances, and societal influences all contribute to the

development of anxiety disorders in children.

b. Like many conditions affecting children, the etiology of anxiety disorders is

unknown.

c. The majority of anxiety disorders have a clear pattern of genetic inheritance.

d. Dysfunctional family patterns are usually identified as the cause of an anxiety

disorder.

ANS: A

Feedback

A Anxiety disorders are responses to stress and may be manifested as disturbances

in feeling, body functions, behavior, or performance. Children with a history of

verbal, physical, or sexual abuse; frequent separation from or loss of loved ones;

drug use, incarceration, or lower socioeconomic status; homosexuality; chronic

illness; behavioral disorders; and dysfunctional families are more likely than

peers with healthy family patterns to have anxiety disorders.

B The etiology of many anxiety disorders in children can be identified.

C Some anxiety disorders are inheritable disorders. Others have been identified as

having other origins.

D Research consistently shows that psychosocial disorders are caused by a

combination of predisposing or inherent factors and environmental or

interactional factors.

In counseling an adolescent who is abusing alcohol, the nurse explains that alcohol abuse

primarily affects which organ of the body?

a. Heart

b. Liver

c. Brain

d. Lungs

ANS: C

Feedback

A Although an excessive amount of a chemical can cause cardiac abnormalities,

the brain is the most commonly affected organ.

B Long-term alcohol use is known to impair the liver; however, brain function is

decreased by any amount of alcohol intake.

C The primary effect of substance abuse is on the brain and residually on the rest of

the body. Alcohol affects the entire brain by decreasing its responsiveness.

D The pulmonary system is not the primary target; however, one commonly abused

drug known to cause pulmonary problems is tobacco.

The outpatient nurse understands that the phase of substance abuse characterized by a

14-year-old child admitting to using marijuana every day with friends after attending

school is

a. Experimentation

b. Early drug use

c. True drug addiction

d. Severe drug addiction

ANS: C

Feedback

A With experimentation, the individual tries the drug to see what it is like or to

satisfy peers.

B Early drug use is identified as using drugs with some degree of regularity for

their desirable effects.

C True drug addiction is identified as regular use of drugs. Physical dependence

may be present. Social functioning has a drug focus.

D In severe drug addiction, the physical condition of the individual deteriorates and

all activities are related to drug use.

The school nurse observes an unkempt child dressed in inappropriate clothing who

repeatedly asks for food. About which problem is the nurse concerned?

a. Physical abuse

b. Physical neglect

c. Emotional abuse

d. Sexual abuse

ANS: B

Feedback

A 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.

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.

C Emotional abuse is manifested by developmental problems or maladaptive

behaviors.

D 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.

A child who has symptoms of irritable mood, changes in sleep and appetite patterns,

decreased self-esteem, and disengagement from family and friends 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

Feedback

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.

B A dysthymic disorder is associated with a depressed or irritable mood for at least

a year.

C A cyclothymic or bipolar mood disorder is characterized by chronic, fluctuating

mood disturbances between depressive lows and highs for a year.

D A panic disorder is a type of anxiety disorder.

What is the goal of therapeutic management for a child diagnosed with ADHD?

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

Feedback

A 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.

B Children with ADHD may have other psychosocial or learning problems;

however, diagnosing these is not the primary goal.

C Interventions to correct nutritional imbalances are the primary focus of care for

eating disorders.

D The primary goal of therapeutic management for the child with ADHD is to

reduce the intensity and frequency of unsocialized behaviors.

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 need for peer approval

d. Deterioration of relationships with family members

ANS: D

Feedback

A 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.

B 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.

C The adolescent with a substance abuse problem may demonstrate an excessive

dependence on peer influence.

D Deterioration of relationships with family members, irregular school attendance,

low grades, rebellious or aggressive behavior, and excessive dependence on peer

influence are behaviors that may indicate substance abuse.

Which behavior verbalized by a school-age child should alert the school nurse to a

problem of possible obsessive-compulsive disorder (OCD)?

a. States feelings of worthlessness and sadness everyday

b. Feels need to ride a bike around the tree in front of the house seven times every

day before entering the house

c. Recurrent episodes of chest pain, heart palpations, and shortness of breath when

entering the computer classroom

d. Deterioration of relationships with family members

ANS: B

Feedback

A Feelings of worthlessness and sadness are suggestive of a depressive disorder.

B Obsessive-compulsive disorder (OCD) manifests repetitive unwanted thoughts

(obsessions) or ritualistic actions (compulsions) or both.

C Panic disorders often cause recurrent episodes of chest pain, heart palpations,

and shortness of breath. These symptoms may be accompanied by a feeling of

impending doom.

D Deterioration of relationships with family members, irregular school attendance,

low grades, rebellious or aggressive behavior, and excessive dependence on peer

influence are behaviors that may indicate substance abuse.

Which finding noted by the nurse on a physical assessment is most suggestive 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

Feedback

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.

B 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.

C Children who have been emotionally abused may exhibit speech disorders, lags

in physical development, failure to thrive, or hyperactive and disruptive

behaviors. Although there is a possibility for speech and developmental delays,

these are not more suggestive of sexual abuse than swollen genitalia and pain on

urination.

D Opiates can cause detachment and apathy, drowsiness, constricted pupils,

constipation, slurred speech, and impaired judgment.

Which manifestation is atypical of ADHD?

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

Feedback

A Talking excessively is a characteristic of impulsivity/hyperactivity.

B 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.

C The child with ADHD tends to be talkative, often interrupting conversations,

rather than withdrawn in social situations.

D Fidgeting is typical of the overactivity that is associated with ADHD.

The parents of a teen suspect their child is using amphetamines. Manifestations of

amphetamine use include (select all that apply)

a. Weight gain

b. Excessive talking and activity

c. Excessive sleeping

d. Insomnia

e. Agitation

ANS: B, D, E

Feedback

Correct: Euphoria, hyperactivity, agitation, irritability, insomnia, weight loss,

tachycardia, and hypertension are expected behaviors and effects of

amphetamine abuse.

Incorrect: The adolescent using amphetamines is likely to have weight loss not

weight gain. Excessive sleeping may be associated with alcohol abuse or

abuse of barbiturates.

A nurse working on the pediatric unit should be aware that children admitted with which

of the following 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

Feedback

Correct: 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.

Incorrect: 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.

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

Feedback

Correct: The risk of suicide increases if the child has had a previous suicide

attempt, a recent loss, or a history of physical abuse.

Incorrect: No previous violence in the home or having an effective social network

decreases the risk of suicide.

The rapid onset of physical, cognitive, and emotional symptoms that results in chest pain,

shortness of breath, and the signs of impending doom is known as ________________.

ANS:

panic disorder

Also referred to as panic attacks. Before considering a diagnosis of panic disorder, organic

causes should be ruled out. These may include hyperthyroidism, hyperglycemia, epilepsy,

and mitral valve prolapse.

Bipolar disorder is characterized by chronic, fluctuating, and extreme mood disturbances.

Onset for this disorder occurs most often during the late preschool to early school-age

stage of development. Is this statement true or false?

ANS: F

Bipolar disorder occurs most often in late adolescence or early adulthood. Depression and

lowered mood, alternate with episodes of the elation and aggression. Impaired social

relationships are common.

Munchausen syndrome by proxy occurs when a person falsifies illness in their child. The

pediatric nurse who is admitting a preschooler with this potential diagnosis understands

that this is the most difficult form of child abuse to diagnose. Is this statement true or

false?

ANS: T

This is correct. The most common reasons these caretakers give for seeking treatment for

the child include: bleeding, seizures, central nervous system depression, apnea, vomiting,

diarrhea, fever, and rash. The parent's behavior reflects a serious psychiatric disturbance

that requires both psychiatric treatment and removal of the child from their care.