Ricci Chapter 50 - Test Bank - 4th Edition

1. The nurse is teaching the mother of a 12-year-old boy about the risk factors

associated with drug and alcohol abuse. Which response by the mother indicates a

need for further teaching?

A) "A family history of alcoholism is a risk factor for substance abuse."

B) "Just because his friends are experimenting does not mean that he

will."

C) "If my husband or I have a substance abuse problem it could increase

his risk."

D) "Negative life events are a potential risk factor."

Ans: B

Feedback:

The nurse needs to emphasize that a peer group that abuses substances is a risk

factor associated with substance abuse and increases the chances of a child

experimenting. Other risk factors include a family history of substance abuse,

current parental substance abuse, and negative life events.

2. The nurse is caring for an adolescent girl with anorexia nervosa. What

findings would indicate to the nurse that the girl requires hospitalization?

A) Weight gain of one-half pound per week

B) Food refusal

C) Body mass index of 18

D) Soft, sparse body hair and dry, sallow skin

Ans: B

Feedback:

Food refusal, severe weight loss, unstable vital signs, arrested pubertal

development, and the need for enteral nutrition warrant hospitalization. Soft,

sparse body hair and dry, sallow skin are signs of anorexia, but do not warrant

hospitalization. A weight gain of one-half pound per week indicates progress toward

therapeutic goals. A body mass index of 18 is on the low end of the normal range of

body mass.

3. The nurse is caring for an adolescent girl with a suspected anxiety disorder.

The girl states that she is constantly double-checking that she has unplugged her

curling iron and must make sure that everything is in perfect order in her room

before she leaves the house. The nurse interprets these findings as indicating which

disorder?

A) Generalized anxiety disorder

B) Posttraumatic stress disorder

C) Social phobia

D) Obsessive-compulsive disorder

Ans: D

Feedback:

Obsessive-compulsive disorder is characterized by compulsions (repetitive

behaviors such as cleaning, washing, or checking something) to reduce anxiety

about obsessions (unwanted and intrusive thoughts). Posttraumatic stress disorder

is an anxiety disorder that occurs after a child is subjected to a traumatic event,

later experiencing physiologic arousal when a stimulus triggers memories of the

event. Generalized anxiety disorder is characterized by unrealistic concerns over

past behavior, future events, and personal competency. Social phobia is

characterized by a persistent fear of formal speaking, using public restrooms, or

eating in front of others.

4. The nurse is caring for a 7-year-old with Tourette syndrome. The nurse

would be alert for which comorbid condition?

A) Depression

B) Anxiety disorder

C) Attention deficit/hyperactivity disorder

D) Asperger syndrome

Ans: C

Feedback:

Attention deficit/hyperactivity disorder and obsessive-compulsive disorders occur in

50% of children with Tourette syndrome. Depression, anxiety disorder, and

Asperger syndrome are not typical comorbid conditions associated with Tourette

syndrome.

5. A nurse is caring for a 10-year-old boy with a nursing diagnosis of ineffective

coping related to an inability to deal with stressors secondary to anxiety. What

action should the nurse to take first?

A) Set clear limits on the child's behavior

B) Teach the child problem-solving skills

C) Encourage a discussion of the child's thoughts and feelings

D) Role model appropriate social and conversation skills

Ans: C

Feedback:

The priority action is to encourage the child to discuss his thoughts and feelings.

This is the initial step toward learning to deal with them appropriately. Setting clear

limits, teaching problem-solving skills, and role modeling skills would be

appropriate as the child begins to learn how to acknowledge and deal with his

feelings.

6. The nurse is caring for a 3-year-old boy. The parents are concerned that he

is exhibiting signs of cognitive delays. Which statement by the parents would lead

the nurse to suspect autism spectrum disorder rather than possible learning

disability?

A) "He is not speaking in complete sentences."

B) "We can understand a lot of what he says, but no one else can."

C) "He seems to be speaking words less and less frequently."

D) "He is unable to sit still for a short story."

Ans: C

Feedback:

Reports of regression or the loss of previously acquired skills points to autism

rather than intellectual disability. Not speaking in complete sentences, others not

being able to understand what the child is saying, and an inability to sit still for a

short story suggest a learning disability.

7. A nurse is caring for a 5-year-old girl with depression. The girl is having

difficulty coping with her feelings of sadness and fear, which stem from her parents'

separation and recent divorce. The girl has been prescribed antidepressant

medication but the mother thinks the girl would benefit from therapy. The nurse

anticipates a referral to a therapist that specializes in:

A) individual therapy.

B) play therapy.

C) behavioral therapy.

D) hypnosis.

Ans: B

Feedback:

Play therapy is designed to change emotional status and encourages the child to act

out feelings of sadness, fear, hostility, or anger. It is particularly beneficial for the younger child. Play therapy, rather than individual therapy, is recommended for the

younger child. Hypnosis promotes deep relaxation, which is not the therapeutic goal

for this child. Behavioral therapy is used to encourage appropriate behavior and

would not address the girl's sadness.

8. The nurse is caring for a 13-year-old boy with a history of inappropriate

behavior. Which statement by the mother would lead the nurse to suspect

oppositional defiant disorder rather than conduct disorder?

A) "He has frequent temper tantrums."

B) "He was pulling the neighbor's dog around by his leash."

C) "He is constantly lying to me."

D) "He has stolen hundreds of dollars from my purse."

Ans: A

Feedback:

Reports of frequent temper tantrums point to oppositional defiant disorder rather

than conduct disorder. Reports of cruelty to animals, excessive lying, and stealing

point to conduct disorder.

9. The nurse is caring for a 5 year old. The child's mother reports that he is

extremely sensitive to sounds that most people do not notice and that he prefers

complete silence. She explains that the boy is resisting going to school due to the

noise and commotion. Additionally, the mother states that he will only wear 100%

cotton clothing with all of the tags cut out. The nurse interprets these findings as

indicating which disorder or condition?

A) Anxiety disorder

B) Sensory processing disorder

C) Depression

D) Obsessive-compulsive disorder

Ans: B

Feedback:

Sensory processing disorder (sensory integration dysfunction) results in

overreaction to different textures and hypersensitivity or hyposensitivity to sensory

input. The reported sensitivities to sound and clothing do not point to an anxiety

disorder, depression, or obsessive-compulsive disorder.

10. The nurse is caring for a child with bipolar disorder. The child is taking

lithium as ordered. The parents inquire about the potential side effects. Which

response by the nurse would be most appropriate?

A) "You might see excessive urination and thirst, tremor, nausea, weight

gain, and diarrhea."

B) "He might experience a significant decrease in his appetite and

difficulty sleeping."

C) "You need to watch for dry mouth, urinary retention, and

constipation."

D) "This medication can cause seizures, agitation, headache, and

nausea."

Ans: A

Feedback:

The nurse needs to explain that the potential side effects of lithium include polyuria,

polydipsia, tremors, nausea, weight gain, and diarrhea. Decreased appetite and

difficulty sleeping are associated with psychostimulants. Anticholinergic effects such

as dry mouth, urinary retention, and constipation are often associated with tricyclic

antidepressants as well as a-agonist antihypertensive agents such as clonidine.

Seizures, agitation, headache, and nausea are associated with atypical

antipsychotic agents.

11. A child with attention deficit/hyperactivity disorder is prescribed long-acting

methylphenidate. What information would the nurse include when teaching the

child and his parents about this drug?

A) "Give the drug three times a day: morning, midday, and after school."

B) "This drug may cause drowsiness, so be careful when doing things."

C) "Some increase in appetite may occur, so watch how much you eat."

D) "Take this drug every day in the morning when you wake up."

Ans: D

Feedback:

Long-acting methylphenidate is administered once daily in the morning, whereas

the other forms are given three times a day. The drug typically causes difficulty

sleeping and decreased appetite.

12. When reviewing the medical record of a child, what would the nurse interpret

as the most sensitive indicator of intellectual disability?

A) History of seizures

B) Preterm birth

C) Vision deficit

D) Language delay

Ans: D

Feedback:

Due to the extent of cognition required to understand and produce speech, the

most sensitive early indicator of intellectual disability is delayed language

development. A history of seizures, preterm birth, and vision deficit may be

associated with intellectual disability but are not the most sensitive indicators.

13. A school-age child diagnosed with depression is receiving antidepressant

therapy. What behavior would the nurse instruct the parents to watch for and to

notify the healthcare provider immediately if the child demonstrates it?

A) Loss of interest

B) Gastric upset

C) Sedation

D) Urinary retention

Ans: A

Feedback:

Children taking antidepressants are at risk for the development of presuicidal

behavior, which may be indicated by a loss of interest or pleasure. Gastric upset,

sedation, and urinary retention may or may not occur, but none of these would be

as important to report as the potential for self-harm.

14. What would lead the nurse to suspect that an adolescent has bulimia?

A) Body mass index less than 17

B) Calluses on back of knuckles

C) Nail pitting

D) Bradycardia

Ans: B

Feedback:

The adolescent with bulimia would exhibit calluses on the back of the knuckles and

split fingernails and would be of normal weight or slightly overweight. A body mass

index of 17, nail pitting, and bradycardia would suggest anorexia.

15. A child with depression is prescribed fluoxetine. The nurse identifies this as

belonging to which class of drugs?

A) Atypical antidepressant

B) Tricyclic antidepressant

C) Selective serotonin reuptake inhibitor

D) Psychostimulant

Ans: C

Feedback:

Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor. Trazodone is an

atypical antidepressant; amitriptyline, desipramine, imipramine, and nortriptyline

are tricyclic antidepressants. Methylphenidate and the amphetamines are

psychostimulants.

16. A child is receiving therapy in which he is learning to replace automatic

negative thought patterns with alternative ones. The nurse interprets this as which

type of therapy?

A) Cognitive therapy

B) Behavioral therapy

C) Milieu therapy

D) Individual therapy

Ans: A

Feedback:

Cognitive therapy teaches children to change reactions so that automatic negative

thought patterns are replaced with alternative ones. Behavioral therapy uses

stimulus and response conditioning to manage or alter behavior, reinforcing desired

behaviors and replacing the inappropriate ones. Milieu therapy involves a specially

structured setting designed to promote the child's adaptive and social skills. With

individual therapy, the child and therapist work together to resolve the conflicts,

emotions, or behavior problems.

17. A nurse is preparing a program for a parent group about various techniques

that can be used to manage behavior. What would the nurse be least likely to

include?

A) Focus the child's attention on the negative behavior.

B) Set limits with the child for responsible behavior.

C) Ignore inappropriate behaviors.

D) Provide positive feedback for self-control efforts.

Ans: A

Feedback:

Behavior management techniques include redirecting the child's attention when

needed, setting limits for responsible behavior, ignoring inappropriate behaviors,

and providing praise and positive feedback for the child's self-control efforts.

18. The nurse is reviewing the medical record of a child who has dyspraxia. This

child will experience difficulty with:

A) reading and writing.

B) mathematics and computation.

C) manual dexterity and coordination.

D) composition and spelling.

Ans: C

Feedback:

Dyspraxia refers to problems with manual dexterity and coordination. Dyslexia

involves difficulty with reading, writing, and spelling. Dyscalculia involves problems

with mathematics and computation. Dysgraphia involves difficulty producing the

written word in composition, spelling, and writing.

19. A nurse is conducting a screening program for autism in infants and children.

What would the nurse identify as a warning sign?

A) Lack of babbling by 6 months

B) Inability to say a single word by 16 months

C) Lack of gestures by 8 months

D) Inability to use two words by 18 months

Ans: B

Feedback:

Warning signs of autism include no babbling by 12 months, no pointing or using

gestures by 12 months, no single words by 16 months, no two-word utterances by

24 months, and loss of language or social skills at any age.

20. A nurse is preparing a teaching session for a group of parents with children

newly diagnosed with attention deficit/hyperactivity disorder (ADHD). When

explaining this disorder to the parents, what would the nurse include as being

involved? Select all that apply.

A) Impulsivity

B) Inattention

C) Distractibility

D) Hyperactivity

E) Defiance

F) Anxiety

Ans: A, B, C, D

Feedback:

ADHD is characterized by inattention, impulsivity, distractibility, and hyperactivity.

Anxiety disorder and oppositional defiant disorder may be comorbidities associated

with ADHD.

21. A school nurse is working with the parents of an 8-year-old who has Tourette

syndrome on how best to accommodate the child. What advice would be most

helpful? Select all that apply.

A) Allowing for breaks when tics occur

B) Providing for "time-outs" during the day

C) Using a tape recorder to take notes

D) Ensuring a specified amount of time for test taking

E) Implementing a reward system for behavior

Ans: A, C

Feedback:

Together the school nurse and parents should arrange for classroom

accommodations such as allowing for "tic breaks," taking untimed tests or tests in

another room, or using note takers or tape recorders. Time-outs and reward

systems are more appropriate for the child with ADHD.

22. When assessing the adolescent with anorexia, what would the nurse expect

to find?

A) Tachycardia

B) Hypertension

C) Fever

D) Sparse body hair

Ans: D

Feedback:

An adolescent with anorexia often exhibits a low body temperature; bradycardia;

and hypotension; as well as soft, sparse body hair and thinning scalp hair.

23. After teaching the parents of a child with attention deficit/hyperactivity

disorder about ways to control the child's behavior, the nurse determines a need for

additional teaching when the parents state:

A) "If he starts to act out, we'll have him do a time-out to help him

refocus."

B) "We can use a reward system when he behaves appropriately."

C) "If he misbehaves, we need to punish him instead of reward him."

D) "We need to help him set realistic goals that he can achieve."

Ans: C

Feedback:

Punishment for misbehaving would be inappropriate because it would lead to

negative feelings and further decrease self-esteem. Appropriate behavior

management strategies include time-outs, positive reinforcement, reward or

privilege withdrawal, or a token system. Setting realistic goals also is helpful to

foster self-esteem and independence.

24. A nurse is reviewing the medical record of an 11-year-old child with a

conduct disorder. What would the nurse identify as characteristics of this disorder?

Select all that apply.

A) Easily annoyed

B) Initiator of physical fights

C) Temper tantrums

D) Truancy

E) Arrest for arson

Ans: B, D, E

Feedback:

Behaviors associated with conduct disorder include initiation of physical fights,

arson, and truancy. Becoming easily annoyed and experiencing temper tantrums

are associated with oppositional defiant disorder.

25. The nurse identifies a nursing diagnosis of impaired social interaction related

to altered social skills as evidenced by impulsivity and intrusive behavior. The nurse

plans to identify factors that aggravate the child's behavior for which reason?

A) Minimize stimuli that exacerbate the child's undesired behaviors.

B) Improve the child's ability to deal with external stressors.

C) Promote increased ability to follow through.

D) Encourage the child to adopt expectations into his routine.

Ans: A

Feedback:

The nurse identifies aggravating factors to help minimize stimuli that exacerbate

the child's undesired behaviors. This must be accomplished first before any other

interventions would be effective. Improving the child's ability to deal with external

stressors is achieved by modifying the environment to decrease distracting stimuli.

Actions such as speaking directly to the child and maintaining eye contact promote

engagement and an increased ability to follow through. Providing positive feedback

encourages the child to adopt expectations into his routine.

26. A child is prescribed trazodone. What would the nurse be least likely to

include in the plan of care related to this drug?

A) Monitoring blood pressure for orthostatic hypotension

B) Assessing the child for sedation and drowsiness

C) Administering the drug with a snack

D) Monitoring for tardive dyskinesia

Ans: D

Feedback:

Trazodone does not cause tardive dyskinesia; antipsychotics do. It can cause

orthostatic hypotension, sedation, and drowsiness. It should be given after meals or

with snacks to minimize gastrointestinal upset.

27. The nurse is preparing an educational program on behavioral management

techniques used in children to help alter negative behavior. What information

should the nurse include? Select all that apply.

A) Set limits and hold the child responsible for their behavior.

B) Do not argue, bargain, or negotiate about the limits once established.

C) Change caregivers occasionally so the child learns to respond to

different people.

D) Use a high-pitched voice and remain calm when speaking with the

child.

E) Ignore inappropriate behaviors.

Ans: A, B

Feedback:

Behavior management techniques include setting limits and holding the child

responsible for his or her behavior. Not arguing, bargaining, or negotiating about

the limits once established. Inappropriate behaviors should be ignored. Provide

consistent caregivers and establish a daily routine. Use a low-pitched, not highpitched

voice and remain calm when speaking with the child.

28. The nurse is speaking with a parent regarding their child's recent diagnosis of

oppositional defiant disorder. Which statement by the parent would cause the nurse

to question the diagnosis?

A) "I am so tired of arguing with my daughter all the time."

B) "My son purposely does exactly the opposite of what his father tells

him to do."

C) "I feel so bad that my daughter intentionally hurt the neighbor's cat."

D) "My daughter gets so annoyed at me when she doesn't get her way."

Ans: C

Feedback:

Common behaviors in oppositional defiant disorder include excessive arguing with

adults, active defiance, noncompliance with adult requests or limits and easily

annoyed. Physical cruelty to animals or people is associated with conduct disorder,

not oppositional defiant disorder.

29. The nurse is caring for a child who takes dextroamphetamine for treatment

of ADHD. Which comments by the client or family would concern the nurse? Select

all that apply.

A) "I take my sustained released capsule at night before I go to bed."

B) "We have noticed that our child shows very little emotion over the last

few weeks."

C) "I haven't noticed any difference in my appetite."

D) "Sometimes my head hurts a little for a short time after I take my

medicine."

E) "We notice our child gets a little irritable occasionally."

Ans: A, B

Feedback:

Psychostimulants, such as dextroamphetamine, should be taken in the morning in

order to avoid difficulty sleeping. A flat affect is a sign of dosages that are too high.

Decreased appetite, headache, and irritability are common side effects.

30. The nurse working in a pediatric mental health clinic is assessing a 4-year-old

child who has suffered from physical abuse. Which type of therapy does the nurse

anticipate will be most helpful in developing a trusting relationship as well as

assisting in determining the client's current emotional state?

A) Behavioral therapy

B) Play therapy

C) Cognitive behavioral therapy

D) Family therapy

Ans: B

Feedback:

Play therapy will be most helpful, especially in the initial phase of assessment,

because it encourages the child to act out feelings of sadness, fear, hostility, or

anger.