Abuse and Mental Health Problems NCLEX Questions with Rationale

NCLEX Abuse and Mental Health Problems Questions

Abuse and Mental Health Problems NCLEX Practice Questions

Question 1.
A married female client has been referred to the mental health center because she is depressed. The nurse notices bruises on her upper arms and asks about them. After denying any problems, the client starts to cry and says, “He did not really mean to hurt me, but I hate for the kids to see this. I am so worried about them.” What is the most crucial information for the nurse to determine?
(a) the type and extent of abuse occurring in the family
(b) the potential of immediate danger to the client and her children
(c) the resources available to the client
(d) whether the client wants to be separated from her husband
Answer:
(b) the potential of immediate danger to the client and her children

Explanation:
The safety of the client and her children is the most immediate concern. If there is immediate danger, action must be taken to protect them. The other options can be discussed after the client’s safety is assured.

Question 2.
A client with suspected abuse describes her husband as a good man who works hard and provides well for his family. She does not work outside the home and states that she is proud to be a wife and mother just like her own mother. The nurse interprets the family pattern described by the client as best illustrating which characteristic of abusive families?
(a) tight, impermeable boundaries
(b) unbalanced power ratio
(c) role stereotyping
(d) dysfunctional feeling tone
Answer:
(c) role stereotyping

Explanation:
The traditional and rigid gender roles described by the client are examples of role stereotyping. Impermeable boundaries, unbalanced power ratio, and dysfunctional feeling tone are also common in abusive families.
 
Question 3.
When planning the care for a client who is being abused, which measure is most important to include?
(a) being compassionate and empathetic
(b) teaching the client about abuse and the cycle of violence
(c) explaining to the client about the client’s personal and legal rights
(d) helping the client develop a safety plan
Answer:
(d) helping the client develop a safety plan

Explanation:
The client’s safety, including the need to stay alive, is crucial. Therefore, helping the client develop a safety plan is most important to include in the plan of care. Being empathetic, teaching about abuse, and explaining the person’s rights are also important after safety is ensured.

Question 4. 
A nurse is assessing a client who is being abused. The nurse should assess the client for which characteristic(s)? Select all that apply.
(a) assertiveness
(b) self-blame
(c) alcohol abuse
(d) suicidal thoughts
(e) guilt
Answer:
(b) self-blame
(c) alcohol abuse
(d) suicidal thoughts
(e) guilt

Explanation:
(b), (c), (d), (e) The victim of abuse is usually compliant with the spouse and feels guilt, shame, and some responsibility for the battering. Self-blame, substance abuse, and suicidal thoughts and attempts are possible dysfunctional coping methods used by abuse victims. The victim of abuse is not likely to demonstrate assertiveness.

Question 5.
5 After months of counseling, a client abused by her husband tells the nurse that she has decided to stop treatment. There has been no abuse during this time, and she feels better able to cope with the needs of her husband and children. How should the nurse begin the discussion of the decision with the client?
(a) Tell the client that this is a bad decision that she will regret in the future.
(b) Find out more about the client’s rationale for her decision to stop treatment.
(c) Warn the client that abuse commonly stops when one partner is in treatment, only to begin again later.
(d) Remind the client of her duty to protect her children by continuing treatment. 
Answer:
(b) Find out more about the client’s rationale for her decision to stop treatment.

Explanation:
The nurse needs more information about the client’s decision before deciding what intervention is most appropriate. Judgmental responses could make it difficult for the client to return for treatment should she want to do so. Telling the client that this is a bad decision that she will regret is inappropriate because the nurse is making an assumption. Warning the client that abuse commonly stops when one partner is involved in treatment may be true for some clients. 

However, until the nurse determines the basis for the client’s decision, this type of response is an assumption and therefore inappropriate. Reminding the client about her duty to protect the children would be appropriate if the client had talked about episodes of current abuse by her partner and the fear that her children might be hurt by him, but the scenario offers no evidence that the husband has threatened the children.

Question 6.
A school-age child is referred to the mental health clinic by the school nurse because he is fearful, anxious, and socially isolated. After meeting with the client, the nurse talks with his mother, who says, “It’s that school nurse again. She’s done nothing but try to make trouble for our family since my son started school. And now you’re in on it.” What is the nurse’s most appropriate response?
(a) “The school nurse is concerned about your son and is only doing her job.”
(b) “You don’t need to feel singled out. We see a number of children who go to your son’s school.”
(c) “You sound pretty angry with the school nurse. Tell me what’s happened.”
(d) “Let me tell you why your son was referred, and then you can tell me about your concerns.”
Answer:
(c) “You sound pretty angry with the school nurse. Tell me what’s happened.”

Explanation:
The mother’s feelings are the priority here. Addressing the mother’s feelings and asking for her view of the situation is most important in building
a relationship with the family. Ignoring the mother’s feelings will hinder the relationship. Defending the school nurse and the school puts the client’s mother on the defensive and stifles communication.

Question 7.    
The parent of a school-age child tells the nurse that, “For most of the past year, my husband was unemployed, and I worked a second job. Twice during the year I spanked my son repeatedly when he refused to obey. It hasn’t happened again. Our family is back to normal.” After assessing the family, the nurse decides that the child is still at risk for abuse. Which observation best supports this conclusion?
(a) The parents say they are taking away privileges when their son refuses to obey.
(b) The child has talked about family activities with the nurse.
(c) The parents are less negative toward the nurse.
(d) The child wears long-sleeved shirts and long pants, even in warm weather.
Answer:
(d) The child wears long-sleeved shirts and long pants, even in warm weather.

Explanation:
Parental use of nonviolent discipline, the child’s talk about what the family is doing, and the easing of the parent’s negativity toward the school nurse are all signs of progress. Avoidance and wearing clothes inappropriate for the weather implies that the child has something to hide, likely signs of physical abuse.

Question 8. 
When caring for a client who was a victim of a crime, the nurse is aware that recovery from any crime can be a long and difficult process depending on the meaning it has for the client. What should the nurse establish as a victim’s ultimate goal in reconstructing his or her life?
(a) getting through the shock and confusion
(b) carrying out home and work routines
(c) resolving grief over any losses
(d) regaining a sense of security and safety
Answer:
(d) regaining a sense of security and safety

Explanation:
Ultimately, a victim of a crime needs to move from being a victim to being a survivor. A reasonable sense of safety and security is key to this transition. Getting through the shock and confusion, carrying out home and work routines, and resolving grief over any losses represent steps along the way to becoming a survivor.

Question 9.    
A client tells the nurse that she has been raped but has not reported it to the police. After determining whether the client was injured, whether it is still possible to collect evidence, and whether the client wants to file a report, the nurse’s next priority is to offer which intervention to the client?
(a) legal assistance
(b) crisis intervention
(c) a rape support group
(d) medication for disturbed sleep
Answer:
(b) crisis intervention

Explanation:
The experience of rape is a crisis. Crisis intervention services, especially with a rape crisis nurse, are essential to help the client begin dealing with the aftermath of a rape. Legal assistance may be recommended if the client decides to report the rape and only after crisis intervention services have been provided. A rape support group can be helpful later in the recovery process. Medications for sleep disturbance, especially benzodiazepines, should be avoided if possible. Benzodiazepines are potentially addictive and can be used in suicide attempts, especially when consumed with alcohol.

Question 10.    
In working with a rape victim, which intervention is most important?
(a) continuing to encourage the client to report the rape to the legal authorities
(b) recommending that the client resume sexual relations with her partner as soon as possible
(c) periodically reminding the client that she did not deserve and did not cause the rape
(d) telling the client that the rapist will eventually be caught, put on trial, and jailed
Answer:
(c) periodically reminding the client that she did not deserve and did not cause the rape

Explanation:
Guilt and self-blame are common feelings that need to be addressed directly and frequently. The client needs to be reminded periodically that she did not deserve and did not cause the rape. Continually encouraging the client to report the rape pressures the client and is not helpful. In most cases, resuming sexual relations is a difficult process that is not likely to occur quickly. It is not necessarily true that the rapist will be caught, tried, and jailed. Most rapists are not caught or convicted.

Question 11.    
In the process of dealing with intense feelings about being raped, victims commonly verbalize that they were afraid they would be killed during the rape and wish that they had been. The nurse should decide that further counseling is needed if the client makes which statement?
(a) “I didn’t fight him, but I guess I did the right thing because I’m alive.”
(b) “Suicide would be an easy escape from all this pain, but I couldn’t do it to myself.”
(c) “I wish they gave the death penalty to all rapists and other sexual predators.”
(d) “I get so angry at times that I have to have a couple of drinks before I sleep.”
Answer:
(d) “I get so angry at times that I have to have a couple of drinks before I sleep.”

Explanation:
Use of alcohol reflects unhealthy coping mechanisms. The client’s report of needing alcohol to calm down needs to be addressed. Survival is the most important goal during a rape. The client’s acknowledging this indicates that she is aware that she made the right choice.

Although suicidal thoughts are common, the statement that suicide is an easy escape but the client would be unable to do it indicates low risk. Fantasies of revenge, such as giving the death penalty to all rapists, are natural reactions and are a problem only if the client intends to carry them out directly.

Question 12.    
One of the myths about sexual abuse of young children is that it usually involves physically violent acts. Which behavior is more likely to be used by the abusers?
(a) tying the child down
(b) bribery with money
(c) coercion as a result of the trusting relationship
(d) asking for the child’s consent for sex
Answer:
(c) coercion as a result of the trusting relationship

Explanation:
Coercion is the most common strategy used because the child commonly trusts the abuser. Tying the child down usually is not necessary. Typically, the abusive person can control the child by his or her size and weight alone. Bribery usually is not necessary because the child wants love and affection from the abusive person, not money. Young children are not capable of giving consent for sex before they develop an adult concept of what sex is.

Question 13. 
A preadolescent child is suspected of being sexually abused because he demonstrates the self-destructive behaviors of self-mutilation and attempted suicide. Which common behavior should the nurse also expect to assess?
(a) inability to play
(b) truancy and running away
(c) head banging
(d) overcontrol of anger
Answer:
(b) truancy and running away

Explanation:
Truancy and running away are common symptoms for young children and adolescents. The stress of the abuse interferes with school success, leading to the avoidance of school. Running away is an effort to escape the abuse and/or lack of support at home. Rather than an inability to play or a lack of play, play is likely to be aggressive with sexual overtones. Children tend to act out anger rather than control it. Head banging is a behavior typically seen with very young children who are abused.

Question 14.    
Adolescents and adults who were sexually abused as children commonly mutilate themselves. How does the nurse interpret this behavior?
(a) the need to make themselves less sexually attractive
(b) an alternative to binging and purging
(c) use of physical pain to avoid dealing with emotional pain
(d) an alternative to getting high on drugs
Answer:
(c) use of physical pain to avoid dealing with emotional pain

Explanation:
Dealing with the physical pain associated with mutilation is viewed as easier than dealing with the intense anger and emotional pain. The client fears an aggressive outburst when anger and emotional pain increase. Self-mutilation seems easier and safer. Additionally, self-mutilation may occur if the client feels unreal or numb or is dissociating.

Here, the mutilation proves to the client that he or she is alive and capable of feeling. The client may want to be less sexually attractive, but this aspect usually is not related to self-mutilation. Binging and purging is commonly done in addition to, not instead of, self-mutilation. Although a few clients report an occasional high with self-mutilation, usually the experience is just relief from anger and rage.

Question 15.    
A young child who has been sexually abused has difficulty putting feelings into words. Which approach should the nurse employ with the child?
(a) engaging in play therapy
(b) role-playing
(c) giving the child’s drawings to the abuser
(d) reporting the abuse to a prosecutor
Answer:
(a) engaging in play therapy

Explanation:
The dolls and toys in a play therapy room are useful props to help the child remember situations and reexperience the feelings, acting out the experience with the toys rather than putting the feelings into words. Role-playing without props commonly is more difficult for a child. Although drawing itself can be therapeutic, having the abuser see the pictures is usually threatening for the child. Reporting abuse to authorities is mandatory but does not help the child express feelings.

Question 16.    
A client who has been sexually assaulted is admitted to the emergency department (ED). Which is the most important initial statement by the nurse?
(a) “Did you know the person who did this to you?”
(b) “I’ll get the emergency rape kit.”
(c) “I’ll stay with you while you’re here.”
(d) “Don’t worry, trained responders are coming.”
Answer:
(c) “I’ll stay with you while you’re here.”

Explanation:
The priority of care for the client is safety. Staying with the client at all times is a priority. The perpetrator most likely threatened the victim that if she/he informed anyone about the incident, the rapist will severely harm or kill the victim. Staying with the client also support development of trust of the nurse by the client. The question regarding who is the perpetrator is within the realm of the authorities not the nurse.

Leaving the ED to obtain the rape kit is not the safety priority as staying with the client at all times. This action can be delegated to another individual. Telling an individual to “not worry” is nontherapeutic communication and will not allay the fears of the client who has undergone the trauma of a physical sexual assault.

Question 17.    
After a client reveals a history of childhood sexual abuse, what question should the nurse ask first?
(a) “What other forms of abuse did you experience?”
(b) “How long did the abuse go on?”
(c) “Was there a time when you did not remember the abuse?”
(d) “Does your abuser still have contact with young children?”
Answer:
(d) “Does your abuser still have contact with young children?”

Explanation:
The safety of other children is a primary concern. It is critical to know whether other children are at risk for being sexually abused by the same perpetrator. Asking about other forms of abuse, how long the abuse went on, and if the victim did not remember the abuse are important questions after the safety of other children is determined.

Question 18.    
When obtaining a nursing history from parents who are suspected of abusing their child, which characteristic about the parents should the nurse particularly assess?
(a) attentiveness to the child’s needs
(b) self-blame for the injury to the child 
(c) ability to relate the child’s developmental achievements
(d) difficulty with controlling aggression
Answer:
(d) difficulty with controlling aggression

Explanation:
Parents of an abused child have difficulty controlling their aggressive behaviors. They may blame the child or others for the injury, may not ask questions about treatment, and may not know developmental information.

Question 19.    
A preschool-age child with a history of being abused has blood drawn. The child lies very still and makes no sound during the procedure. Which comment by the nurse would be most appropriate?
(a) “It’s okay to cry when something hurts.”
(b) “That really didn’t hurt, did it?”
(c) “We must seem mean to hurt you that way.”
(d) “You were very good not to cry with the needle.”
Answer:
(a) “It’s okay to cry when something hurts.”

Explanation:
It is not normal for a preschooler to be totally passive during a painful procedure. Typically, a preschooler reacts to a painful procedure by crying or pulling away because of the fear of pain. However, an abused child may become “immune” to pain and may find that crying can bring on more pain.

The child needs to learn that appropriate emotional expression is acceptable. Telling the child that it really did not hurt is inappropriate because it is untrue. Telling the child that nurses are mean does not build a trusting relationship. Praising the child will reinforce the child’s response not to cry, even though it is acceptable to do so.

Question 20.    
While interviewing a preschool-age girl who has been sexually abused about the event, which approach would be most effective?
(a) Describe what happened during the abusive act.
(b) Draw a picture and explain what it means.
(c) “Play out” the event using anatomically correct dolls.
(d) Name the perpetrator.
Answer:
(c) “Play out” the event using anatomically correct dolls.

Explanation:
A 3-year-old child has limited verbal skills and should not be asked to describe an event, explain a picture, or respond verbally or nonverbally to questions. More appropriately, the child can act out an event using dolls. The child is likely to be too fearful to name the perpetrator or will not be able to do so.

Question 21.
Which observation by the nurse should suggest that a 15-month-old toddler has been abused?
(a) The child appears happy when personnel work with him.
(b) The child plays alongside others contentedly.
(c) The child is underdeveloped for his age.
(d) The child sucks his thumb.
Answer:
(c) The child is underdeveloped for his age.

Explanation:
An almost universal finding in descriptions of abused children is underdevelopment for age. This may be reflected in small physical size or in poor psychosocial development. The child should be evaluated further until a plausible diagnosis can be established.

A child who appears happy when personnel work with him is exhibiting normal behavior. Children who are abused often are suspicious of others, especially adults. A child who plays alongside others is exhibiting normal behavior, that of parallel play. A child who sucks his thumb contentedly is also exhibiting normal behavior.

Question 22.    
When planning interventions for parents who are abusive, the nurse should incorporate knowledge of which factor as a common parental indicator?
(a) lower socioeconomic group
(b) unemployment
(c) low self-esteem
(d) loss of emotional family attachments
Answer:
(c) low self-esteem

Explanation:
Parents who are abusive often suffer from low self-esteem, commonly because of the way they were parented, including not being able to develop trust in caretakers and not being encouraged or offered emotional support by parents. Therefore, the nurse works to bolster the parents’ self-esteem. This can be achieved by praising the parents for appropriate parenting.

Employment and socioeconomic status are not indicators of abusive parents. Abusive parents usually are attached to their children and do not want to give them up to foster care. Parents who are abusive usually love their children and feel close to them emotionally.

Question 23.    
An adolescent client is being admitted with an eating disorder. Which initial assessment finding is of greatest concern for the nurse?
(a) a systolic blood pressure of 100 mm Hg
(b) a weight loss of 10% over 6 months
(c) a potassium level of 2.5 mEq/L (2.5 nmiol/L)
(d) a heart rate of 57 bpm
Answer:
(c) a potassium level of 2.5 mEq/L (2.5 nmiol/L)

Explanation:
Hypokalemia can result from excessive vomiting or laxative use in clients with eating disorders. Potassium levels of 2.5 mEq/L (2.5 mmol/L) or less are considered life-threatening and in need of urgent attention. A 10% weight loss over 6 months indicates gradual rather than rapid weight loss. Depending on the client’s height and exact age, a systolic blood pressure of 100 mm Hg can be with normal limits. Low heart rates are frequently seen in clients with very restricted calorie intakes. While a heart rate of 57 bpm indicates bradycardia, if there are no other signs of poor perfusion, it is not immediately life-threatening.

Question 24.    
The nurse is planning an eating disorder protocol for hospitalized clients experiencing bulimia and anorexia. Which elements should be included in the protocol? Select all that apply.
(a) Clients must eat within view of a staff member.
(b) Clients are not told their weight and cannot see their weight while being weighed.
(c) Clients must rest within view of a staff member for one-half hour to an hour after eating.
(d) Clients may not go to the bathroom for one- half hour to an hour after eating.
(e) Clients cannot participate in any groups after admission until they gain 1 lb (0.5 kg).
Answer:
(a) Clients must eat within view of a staff member.
(b) Clients are not told their weight and cannot see their weight while being weighed.
(c) Clients must rest within view of a staff member for one-half hour to an hour after eating.
(d) Clients may not go to the bathroom for one- half hour to an hour after eating.

Explanation:
(a), (b), (c), (d) In hospital settings, clients are not allowed to know their weight at the time they are being weighed to decrease obsessing about weight gain. They must also eat and rest in staff view and cannot use the bathroom for a period to prevent discarding food or vomiting ingested food (purging). The rest prevents the client from exercising off the calories they just consumed. Barring clients from attending groups until they have gained weight diminishes the therapeutic value of the inpatient hospital stay.

Question 25.
A hospitalized adolescent diagnosed with anorexia nervosa refuses to comply with her daily before-breakfast weigh-in. She states that she just drank a glass of water, which she feels will unfairly increase her weight. What is the nurse’s best response to the client?
(a) “You’re here to gain weight so that will work in your favor.”
(b) “Don’t drink or eat for 2 hours, and then I’ll weigh you.”
(c) “You must weigh in every day at this time.  Please step on the scale.”
(d) “If you don’t get on the scale, I’ll be forced to call your health care provider.”
Answer:
(c) “You must weigh in every day at this time.  Please step on the scale.”

Explanation:
In responding to the client, the nurse must be nonjudgmental and matter of fact. Telling her that weight gain is in her favor ignores the client’s extreme fear of gaining weight. Putting off the weigh-in for 2 hours allows the client to manipulate the nurse and interferes with the need to weigh the client at the same time each day. Threatening to call the care provider is not likely to build rapport or a working relationship with the client.

Question 26.    
The nurse discovers that an adolescent client with anorexia nervosa is taking diet pills rather than complying with the diet. What should the nurse do
first?
(a) Explain to the client how diet pills can jeopardize health.
(b) Listen to the client discuss fears of losing control of eating while being treated.
(c) Talk with the client about how weight loss worry the health care providers (HCPs).
(d) Inquire about worries of the client’s family concerning the client’s health.
Answer:
(b) Listen to the client discuss fears of losing control of eating while being treated.

Explanation:
A client with anorexia nervosa commonly has an extreme fear of not being able to control weight. The nurse should address this fear. Explaining the dangers of diet pills or discussing the HCPG or family concerns focuses on the effect of  the client’s weight loss on other people rather than the client. Unless the client is motivated to stop, the client will likely not be successful.

Question 27.    
When teaching a group of adolescents about anorexia nervosa, the nurse should describe this disorder as being characterized by which factors?
(a) excessive fear of becoming obese, near-normal weight, and a self-critical body image
(b) obsession with the weight of others, chronic dieting, and an altered body image
(c) extreme concern about dieting, calorie counting, and an unrealistic body image
(d) intense fear of becoming obese, emaciation, and a disturbed body image
Answer:
(d) intense fear of becoming obese, emaciation, and a disturbed body image

Explanation:
An intense fear of becoming obese, emaciation, and a disturbed body image all are considered to be characteristics of anorexia nervosa. Nearnormal weight is not associated with anorexia. The weight of others is not a primary factor. “Concern about dieting” is not strong enough language to describe the control of food intake in the individual with anorexia nervosa.

Question 28. 
The nurse reviews laboratory work for a client who is admitted to the acute psychiatric unit for an eating disorder. Which finding does the nurse report to the health care provider? Select all that apply

Test	Result Traditional Units	Results SI Units
1. Albium level	2.8 g/dl	28 g/dl
2. Sodium level	145 m/Eql	145 mmol/L
3. Hemoglobin level	10.8 g/dl	108 g/L
4. Potassium level	2.7 mEq/l	2.7 mmol/L
5. Hematocrit level	37%	0.37

(a) albumin level
(b) sodium level
(c) hemoglobin level
(d) potassium level
(e) hematocrit level
 Answer:
(a) albumin level
(c) hemoglobin level
(d) potassium level

Explanation:
(a), (c), (d) The normal albumin level is 3.5 to 5 g/dL (35 to 50 g/L), the normal hemoglobin level is 12 to 16 g/dL (120 to 160 g/L), and the normal potassium is 3.5 to 5 mEq/L (3.5 to 5 mmol/L). These levels are all low. The client is likely not eating a sufficient amount of protein; therefore, the albumin and hemoglobin are low. The potassium level would be low if the client was purging. The sodium level is normally 136 to 145 mEq/L (136 to 145 mmol/L), so this is in the normal range; however, it can be high in a client with an eating disorder. The normal hematocrit level is 37% to 47% (0.37 to 0.47) in an adult.

Question 29.    
The parents of an adolescent client newly diagnosed with anorexia nervosa are meeting with the nurse during the admission process. Which remarks should the nurse interpret as typical for parents of a client with anorexia nervosa?
(a) “We’ve given her everything, and look how she repays us!”
(b) “She’s had behavior problems for the past year both at home and at school.”
(c) “She’s been a model child. We’ve never had any problems with her.”
(d) “We have five children, all normal kids with some problems at times.”
Answer:
(c) “She’s been a model child. We’ve never had any problems with her.”

Explanation:
Parents commonly describe their child as a model child who is a high achiever and compliant. These adolescents are typically well liked by teachers and peers. It is not typical for behavior problems to be reported. The description about having given the child everything and being repaid is more likely to describe an adolescent who is exhibiting behavior problems.

Question 30.    
A young adult female client is brought to the emergency department by her roommate to seek treatment for gastrointestinal problems. The client reveals that she attends college and works at a coffee shop each evening. A diet history indicates that the client has unhealthy eating habits, commonly eating large amounts of carbohydrates and junk food with few fruits and vegetables. “Her stomach is upset a lot,” the roommate says. She further reports that the client is “in the bathroom all the time.” Which referral is most important for the nurse to make for the for the client?
(a) a mental health clinic
(b) a weight loss program
(c) an overeating support group
(d) the client’s health care provider (HCP)
Answer:
(a) a mental health clinic

Explanation:
The large carbohydrate intake and significant time in the bathroom are characteristics of bulimia. To address the problem, the client must obtain an evaluation of her physical and psychological status. Suggesting going to a weight loss program or overeating support group frames the problem as strictly a weight issue and ignores the psychological etiology of the problem. Seeing the family’s HCP does not address the psychological aspect of the client’s illness, and the client must make the appointment herself.

Question 31. 
A nurse is working with a client with bulimia. Which goals should be included in the care plan? Select all that apply.
(a) The client will maintain normal weight.
(b) The client will comply with medication therapy.
(c) The client will achieve a positive self-concept.
(d) The client will acknowledge the disorder.
(e) The client will never have the desire to purge again.
Answer:
(a) The client will maintain normal weight.
(b) The client will comply with medication therapy.
(c) The client will achieve a positive self-concept.

Explanation:
(a), (b), (c) Because of the large number of calories ingested in a binge and the fact that a purge does not eliminate all calories consumed, the client with bulimia is of more normal weight but still must have a goal of maintaining that weight. Research has shown that selective serotonin reuptake inhibitors are effective in treating bulimia, and the client is usually amenable to taking the medication.

The client with an eating disorder (bulimia and anorexia) has negative self-concepts that fuel her disordered eating, and attaining a positive self-concept is an appropriate goal. The nurse should work with the client with bulimia to help her recognize her eating as disordered. That recognition can make the client more amenable to treatment. It is not realistic to establish a goal that the client with bulimia will never have the desire to purge again.

Question 32. 
A nurse works with a client diagnosed with bulimia. What is the most appropriate long-term client goal for this client?
(a) Eat meals at home without binging or purging.
(b) Be able to eat out without binging or purging.
(c) Manage stresses in life without binging or purging.
(d) Be able to attend college without binging or purging. 
Answer:
(c) Manage stresses in life without binging or purging.

Explanation:
A successful outcome for a bulimic client is to avoid using the eating disorder as a coping measure when dealing with stress. Being able to attend college, eat at home, and eat out without binging and purging are important goals, but they do not address the primary problem of stress management and its connection to eating.

Question 33.    
A client newly diagnosed with bulimia is attending the nurse-led group at the mental health center. She tells the group that she came only because her husband said he would divorce her if she did not get help. Which response by the nurse is appropriate?
(a) “You sound angry with your husband. Is that correct?”
(b) “You’ll find that you like coming to group. These people are a lot of fun.”
(c) “Tell me more about why you’re here and how you feel about that.”
(d) “Tell me something about what has caused you to be bulimic.”
Answer:
(c) “Tell me more about why you’re here and how you feel about that.”

Explanation:
Encouraging the client to talk about why she is here and her feelings may reveal more information about what led her to come to the group and what led to her diagnosis. It also provides the nurse with valuable information needed to develop an appropriate plan of care. The comment that the client sounds angry presumes what the client is feeling and focuses the talk on her husband. The focus should be on the client, not the husband. 

Telling the client that she will like coming to group imposes the nurse’s view onto the client. The statement also focuses on having fun in the group instead of stressing the therapeutic value. Having the client tell the nurse something about the cause of her bulimia ignores the client’s original statement. In addition, it requires the client to have insight into the cause of her disease, which may not be possible at this point. Also, it may be too early in the relationship to discuss this disorder.

Question 34. 
A client diagnosed with bulimia tells the nurse she only eats excessively when upset with her best friend, and then she vomits to avoid gaining a lot of weight. What should the nurse do next?
(a) Schedule daily family therapy sessions.
(b) Enroll client in a coping skills group.
(c) Work with the client to limit her purging.
(d) Obtain a PRN prescription for lorazepam to reduce binge eating urges.
Answer:
(b) Enroll client in a coping skills group.

Explanation:
Because the client eats excessively when upset, the best treatment would be a group to help her learn alternative coping skills. Trying to limit purging without controlling binging would result in weight gain and likely increase the client’s purging. Daily family therapy sessions are not realistic. Taking lorazepam whenever she feels she needs to binge may temporarily calm the client but does not address the cause of the binging and purging and will lead to drug dependence with long-term use. 

Question 35.
A community health nurse working with a group of fifth-grade girls is planning a primary prevention to help the girls avoid developing eating disorders during their teen years. The nurse should focus on which factor?
(a) working with the school nurse to closely monitor the girls’ weight during middle school
(b) limiting the girls’ access to media images of very thin models and celebrities
(c) telling the girls’ parents to monitor their daughter’s weight and media access
(d) helping the girls accept and appreciate their bodies and feel good about themselves
Answer:
(d) helping the girls accept and appreciate their bodies and feel good about themselves

Explanation:
The goal of a primary prevention program for eating disorders is for the girls to have positive feelings about themselves and their bodies. Monitoring of weight by parents and/or nurses might note eating disorders early, particularly anorexia, but will not address the cause of the disorder. Limiting the girls’ access to media would be impossible and does not prevent distress with one’s body image.

Question 36.
An adolescent client who has been taking an antidepressant for 6 weeks has returned to the clinic for a medication check. When the nurse talks with the client and her parent, the mother reports that she has to remind the client to take her antidepressant every day. The client says, “Yeah, I’m pretty bad about remembering to take my meds, but I never miss a dose because Mom always bugs me about taking it.” Which response would be effective for the nurse to make to the client?
(a) “It’s a good thing your mom takes care of you by reminding you to take your meds.”
(b) “It seems there are some difficulties with being responsible for your medications that we need to address.”
(c) “You’ll never be able to handle your medication administration at college next year if you are so dependent on her.”
(d) “I’m surprised your mother allows you to be so irresponsible.”
Answer:
(b) “It seems there are some difficulties with being responsible for your medications that we need to address.”

Explanation:
The client and mother need to address the issue of responsibility for medication administration. Reinforcing the mother’s overinvolvement in medication taking or making negative comments about the client and mother is unlikely to engage them in problem solving about the matter.

Question 37.
The nurse assesses a school-age client who excessively cleans and categorizes. Her parents report that she has always been orderly, but since her brother died of cancer 6 months ago, her cleaning and categorizing have escalated. In school, she reads instead of playing with other children. These behaviors are now interfering with homework and leisure activities. To bolster her self-esteem, the nurse should encourage the child to engage in which activity?
(a) Serve as a library helper.
(b) Volunteer to organize a party for the class.
(c) Lead a group project with four peers.
(d) Be captain of the kickball team.
Answer:
(a) Serve as a library helper.

Explanation:
This child is demonstrating signs of anxiety and withdrawal. Being a library helper enables the client to use an interest (reading) when interacting with others and gaining pride in helping others. Most interaction will be one-to-one and with adults, which is likely to be more comfortable for her in her state of anxiety. Organizing a class party, a group project with her peers, and a kickball team involve multiple peer interactions, which are likely to be difficult for her at this time. Also, there is no mention of the child liking sports, so kickball would not be an appropriate activity.

Question 38.
An adolescent is a heavy user of marijuana and alcohol. When the nurse confronts the client about his drug and alcohol use, he admits previous heavy use in order to feel more comfortable around peers and achieve social acceptance. He says he has been trying to stay clean since his parents found out and had him seek treatment. When the nurse develops a plan of care with the client, what should be the highest priority to help him maintain sobriety?
(a) peer recognition that does not involve sub stance use
(b) support and guidance from his parents
(c) a strict no drug policy at his high school
(d) the threat of legal charges if caught drinking or smoking marijuana
Answer:
(a) peer recognition that does not involve sub stance use

Explanation:
Peer acceptance and recognition is a very powerful force in the lives of adolescents, leading to positive or negative behavior depending on the child’s peers. While the influence of parents remains strong, peer acceptance combined with the adolescent’s desire for independence can lead to disobeying the parents. The sanctions provided at school and in the community by law enforcement will support those teens that have other support in their lives but are generally not sufficient to prevent substance use in adolescents lacking support at home and with peers.

Question 39. 
An adolescent client is admitted to a psychiatric day treatment program due to severe lower back pain since her mother’s death 3 years ago. Medical examinations have not discovered a physical cause for her pain. She cares for her four younger siblings after school and on weekends because of her father’s long work hours. Which predischarge statement indicates that treatment for her condition has been successful?
(a) “I understand now why my father spends so much time away from home.”
(b) “My back pain is worse on weekends with more responsibility and homework.”
(c) “I do not want to talk about my family. It is my back that is hurting.”
(d) “I just need more rest and relaxation and then my back will feel fine.”
Answer:
(b) “My back pain is worse on weekends with more responsibility and homework.”

Explanation:
This statement indicates insight into possible emotional causes for her pain. After insight is achieved, the client can make behavior changes to effectively cope with her anxiety-related disorder. Saying that she understands why her father is away so often demonstrates insight into her father’s actions rather than her own. Wanting to discuss her pain and not her family indicates denial of any connection between her pain and her stress, which perpetuates her current situation. While rest may help her back, the client's statement does not address psychological issues related to the back pain.

Question 40. 
When collaborating with the health care provider (HCP) to develop the plan of care for a child diagnosed with attention deficit hyperactivity disorder (ADHD), the treatment plan will likely include which treatments?
(a) antianxiety medications, such as buspirone, and homeschooling
(b) antidepressant medications, such as imipramine, and family therapy
(c) anticonvulsant medications, such as carbamazepine, and monthly blood levels
(d) psychostimulant medications, such as meth- ylphenidate, and behavior modification
Answer:
(d) psychostimulant medications, such as meth- ylphenidate, and behavior modification

Explanation:
ADHD is typically managed by psychostimulant medications, such as methylphenidate and pemoline, along with behavior modification. Antianxiety medications, such as buspirone, are not appropriate for treating ADHD. Homeschooling commonly is not a possibility because both parents work outside the home. 

Antidepressants, such as imipra- mine, are indicated for major depressive disorders and must be used with extreme caution in children because they carry the risk of suicidal thinking. Family therapy may be a part of the treatment. Anticonvulsant medications, such as carbamaze- pine, are not appropriate for ADHD. Also, carba- mazepine levels are obtained weekly early during therapy to avoid toxicity and ascertain therapeutic levels.

Question 41.
The nurse meets with the mother of a child diagnosed with attention deficit hyperactivity disorder. The mother states, “I feel so guilty that he has this disease, like I did something wrong. I feel like I need to be with him constantly in order for him to get better. But still sometimes I feel like I’m going to lose control and hurt him.” The nurse should suggest which intervention to the mother?
(a) arranging for respite care to watch her child and give herself a regular break
(b) taking a job to allow herself to feel some suc cess because her child will not ever improve
(c) arranging to have coffee with friends daily as a way to begin a support group
(d) considering foster care if she feels that she cannot handle her child’s problems
Answer:
(a) arranging for respite care to watch her child and give herself a regular break

Explanation:
Suggesting that the mother arrange for respite care so that she can have a regular break would help to alleviate some of the stress that she feels when she is with her child constantly. The mother also could use family and friends to provide some care, thereby helping with giving her a break. The child may improve, so suggesting that the mother take a job to provide a feeling of success would be inappropriate. 

Having coffee daily with friends may provide some opportunities for socialization. However, friends may not be able to provide the verbal support that the mother needs. Rather, attending a support group of other parents with children with attention deficit hyperactivity disorder might be helpful. Placing the child in foster care is an extreme measure that may damage the therapeutic relationship with the nurse and dramatically and negatively affect the relationship between the mother and child.

Question 42. 
The nurse is with the parents of an adolescent client who recently attempted suicide. The nurse cautions the parents to be especially alert for which changes in their child?
(a) expression of a desire to date
(b) decision to try out for an extracurricular activity
(c) giving away valued personal items
(d) desire to spend more time with friends
Answer:
(c) giving away valued personal items

Explanation:
Giving away personal items has consistently been shown to be an indicator of suicide plans in a depressed and suicidal individual. Expression of a desire to date, trying out for an extracurricular activity, or the desire to spend more time with friends indicates a return of interest in normal adolescent activities. 

Question 43. 
An adolescent client has struggled academically throughout high school and realizes during her last semester in school that she is not going to graduate with her class, which will delay her admission to college. In the past, she has intermittently used drugs and alcohol to deal with her anxiety, but now, her involvement with substances escalates to daily use. In what order of priority from first to last should the nurse, who has become aware of the problem, take the actions? All options must be used.
(a) Refer her to the school authorities to address her academic issues so she can graduate next semester.
(b) Refer her to a program at the local community college to improve the client’s readiness for college and decrease her anxiety.
(c) Refer her to an outpatient program that treats clients with chemical dependency issues.
(d) Refer her to a psychiatric clinic so she can get an appropriate diagonosis and medication for her anxiety.
Answer:
(d) Refer her to a psychiatric clinic so she can get an appropriate diagonosis and medication for her anxiety.
(c) Refer her to an outpatient program that treats clients with chemical dependency issues.
(a) Refer her to the school authorities to address her academic issues so she can graduate next semester.
(b) Refer her to a program at the local community college to improve the client’s readiness for college and decrease her anxiety.
 
Explanation:
(d), (c), (a), (b) The client’s anxiety seems to fuel her substance abuse, so treatment for her anxiety is paramount, followed by treatment for substance abuse. Those two interventions should increase her readiness to profit from academic aid offered by the school. Referral to a community college program would help her get ready for college, which will likely decrease her anxiety.
 
Question 44. 
A mother states to the nurse in the health care provider’s (HCP’s) office that she is frustrated regarding her school-age son’s nightly enuresis for the past 3 years. She says she has limited his evening fluids, eliminated all caffeine and soft drinks from his diet, and has had him wash his own sheets, but he still wets the bed almost every night. Her husband has told her he was a bed wetter as a child. He thinks the son will “get over it.” The mother is worried that it could negatively affect the son’s peer relationships as he grows older. Which action should the nurse take?
(a) Reinforce that she should be patient since her husband’s enuresis stopped without intervention.
(b) Suggest asking the HCP about medication treatment to deal with the enuresis.
(c) Discuss a behavioral treatment plan to improve the child’s social skills.
(d) Suggest the mother ask the HCP about a complete renal workup.
Answer:
(b) Suggest asking the HCP about medication treatment to deal with the enuresis.

Explanation:
The mother’s distress and length of time the problem has existed combined with the efforts she has made to address the problem demonstrate that medication treatment should be considered. The absence of any other symptoms makes a renal workup unnecessary at this time. It is unlikely that social skills training alone will change his nocturnal enuresis. Just waiting for the behavior to stop is likely to further tax the mother and son.

Question 45.
A parent of a school-age child diagnosed with attention deficit hyperactivity disorder (ADHD) is talking to the nurse about her concerns about the son’s physical condition. The parent states the methylphenidate, extended release, controls his symptoms well but is causing him to lose weight. It is difficult to get him up and ready for school in the morning unless he is given the medication as soon as he awakens. He does not eat breakfast or very much of his lunch at school; he eats dinner, but only an average amount of food. He has lost 3 lb (1.4 kg) in the last 2 weeks. Which action should the nurse suggest the parent do first?
(a) Have the child eat a breakfast bar, banana, and a glass of milk at his bedside at the same time he takes his medication every morning.
(b) Monitor the child’s weight closely for a month since he is likely to stop losing weight when the school year ends in 2 weeks.
(c) Suggest a change of medication to a nonstim ulant drug that will treat his ADHD without causing the appetite decrease.
(d) Suggest that the parent supplement the child’s dinner with a high-protein drink or other food that will increase his caloric intake. 
Answer:
(b) Monitor the child’s weight closely for a month since he is likely to stop losing weight when the school year ends in 2 weeks.

Explanation:
Because weight loss is a common side effect of methylphenidate and because the child’s symptoms are controlled with the stimulant, the first action should be to increase the child’s oral intake before the medication’s side effects begin. Weight should be monitored, but since the child has already lost weight, a remedy is needed as well as monitor-ing. 

The weight loss is directly due to the medication’s side effects, so the child will continue to lose weight unless an intervention is made whether or not he is enrolled in school or on summer vacation. A high-protein drink could work, but then, the child is taking in all his calories in the evening, which is not best nutritionally. A change of medication should be the last resort because methylphenidate is the most effective medication for ADHD and has been successful with this child.

Question 46. 
An adolescent is brought to the emergency department (ED) after accidentally taking an overdose of heroin. The adolescent is semiconscious, unable to respond appropriately to questions, slurs words, and has constricted pupils; the client’s vital signs are blood pressure 60/50 mm Hg, pulse 50 beats/min, and respirations 8 breaths/min. Naloxone is administered to temporarily reverse the effects of the heroin. Which finding would first indicate that the naloxone administration has been effective?
(a) The client’s blood opiate level drops to a non toxic level.
(b) The client becomes talkative and physically active.
(c) The client’s memory and attention become normal.
(d) The client’s respirations improve to 12/min.
Answer:
(d) The client’s respirations improve to 12/min.

Explanation:
Decreased respirations and coma are the two most dangerous effects of heroin overdose, so an increase in respirations after administration of the naloxone demonstrates initial effectiveness of the medication. Changes in cognition and psychomotor activity will take more time to become apparent. The client’s blood opioid level may not drop to a nontoxic level for a few days.

Question 47.    
Assessment of suicidal risk in children and adolescents requires the nurse to know what information?
(a) Children rarely commit suicide unless one of their parents has already committed suicide, especially in the past year.
(b) The risk of suicide increases during adoles cence, with those who have recently suffered a loss, abuse, or family discord being most at risk.
(c) Children do have a suicidal risk that coincides with some significant event such as a recent gun purchase in the family.
(d) Adolescents typically do not choose suicide unless they live in certain geographical regions of the United States and Canada.
Answer:
(b) The risk of suicide increases during adoles cence, with those who have recently suffered a loss, abuse, or family discord being most at risk.

Explanation:
Adolescents are more likely than children to attempt or commit suicide. Loss, abuse, and family discord remain significant risk factors. There is no evidence to support that children rarely commit suicide. Additionally, evidence fails to support the belief that children who have lost a parent to suicide will attempt it themselves. Significant events, such as a recent firearm purchase, have not been linked to suicide attempts in children. No geographical region in the United States or Canada is free from adolescent suicide.

Question 48.    
A child is being seen at the clinic for an attention deficit hyperactivity disorder (ADHD) assessment. What symptoms the nurse would expect to find? Select all that apply,
(a) excessive climbing and running
(b) excessive fidgeting
(c) pouting behaviors
(d) cannot wait to take turns
(e) easily distracted
Answer:
(a) excessive climbing and running
(b) excessive fidgeting
(c) pouting behaviors
(d) cannot wait to take turns

Explanation:
(a), (b), (c), (d) A child with ADHD will manifest excessive climbing and running, excessive fidgeting, inability to take turns, and distractibility. This child does not exhibit pouting or moody behaviors.

Question 49.
The mother of an adolescent client who is diagnosed with oppositional defiant disorder tells the nurse that she has read extensively on this disorder and does not believe the diagnosis is correct for her daughter. Which response by the nurse is appropriate?
(a) “It sounds like you’re very interested in your daughter. Let’s focus on what is best for her.”
(b) “Tell me what you’ve found in your reading that’s leading you to that conclusion.”
(c) “Your health care provider (HCP) has had many years of education and experience, so you can believe he is right.”
(d) “That doesn’t matter now because we just need to help her get better.”
Answer:
(b) “Tell me what you’ve found in your reading that’s leading you to that conclusion.”

Explanation:
The nurse needs to find out what exactly the mother knows and has read. Reviewing what the mother has found in her reading that is leading her to doubt the diagnosis will help direct the nurse’s teaching and clarify any misperceptions or misinfor-mation that the mother may have. The HCP may indeed have many years of education and experience, and the focus should be on the daughter, but the nurse needs to address the mother’s concerns at this time.

Question 50. 
A young school-age girl whose mother and aunt have been diagnosed as having bipolar disorder and whose father is diagnosed with depression is brought to the clinic because of problems with behavior and attention in school and inability to sleep at night. The child says, “My brain does not turn off at night.” The child is diagnosed as experiencing attention deficit hyperactivity disorder (ADHD) with a possibility of bipolar disorder as well. What should the nurse say to the father
to explain what the provider said? Select all that apply.
(a) “Your child was diagnosed as having ADHD because of her attention and behavior problems at school.”
(b) “ADHD involves difficulty with attention, impulse control, and hyperactivity at school, home, or in both settings.”
(c) “Your provider does not know how to diagnose your child’s illness since she has symptoms of both bipolar disorder and ADHD.”
(d) “The child’s description of her inability to sleep is irrelevant to diagnosing her condition since she stays up late.”
(e) “Your provider is considering a bipolar diagnosis because of your child’s family history of bipolar disorder and her sleep issues.”
Answer:
(a) “Your child was diagnosed as having ADHD because of her attention and behavior problems at school.”
(b) “ADHD involves difficulty with attention, impulse control, and hyperactivity at school, home, or in both settings.”
(e) “Your provider is considering a bipolar diagnosis because of your child’s family history of bipolar disorder and her sleep issues.”

Explanation:
(a), (b), (e) The client’s school problems, the presence of first-degree relatives diagnosed with bipolar disorder and depression, and her inability to sleep at night mirror aspects of both ADHD and bipolar disorder, which are difficult to distinguish from each other in children. Health care providers (HCPs) m are reluctant to diagnose young children as bipolar at this age. She may have only one disorder or the other or both.

Further monitoring and her response to medication will differentiate whether she is suffering from one of the disorders or both. Any comments indicating that the provider does not know what he or she is doing or that the child’s perceptions of her illness are not valid will undermine any trust the father and child might be developing in their caregiver and so should be avoided.

Question 51.    
At the admission interview, the father of a 4-year-old boy with attention deficit hyperactivity disorder (ADHD) says to the nurse, “I know that my wife or I must have caused this disease.” What is the nurse’s best response?
(a) “ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder.”
(b) “What do you think you might have done that could have led to causing this disorder to develop in your son?”
(c) “Many parents feel this way, but I doubt there’s anything that you did that caused ADHD to develop in your child.”
(d) “Let’s not focus on the cause but rather on what needs to be done to help your son get better. I know that you and your wife are very interested in helping him to improve his behavior.” 
Answer:
(a) “ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder.”

Explanation:
Stating that attention deficit hyperactivity disorder occurs more commonly in families takes the opportunity for teaching while also helping the father realize that he and his wife are not to blame. Parents who are commonly blamed by society for their child’s behavior need help with education.

Questioning the father on what he thinks he may have done implies that the parents played some role in this disorder, possibly contributing to the father’s guilt. Telling the father that many parents feel this way and that the nurse does not think the parents are at fault is premature at this point. Telling the father that he should focus on what needs to be done, rather than what caused the disorder, minimizes the father’s concerns and feelings. 

Question 52. 
A member of a nurse-led group for depressed adolescents tells the group that she is not coming back because she is taking medication and no longer needs to talk about her problems. Which response by the nurse is most appropriate?
(a) “I’m glad that you’re taking your medication, but how can we know that you will continue to take it? After all, you haven’t been on it for very long, and you might decide to stop taking it.”
(b) “I think that it’s important to let everyone respond to what you said, so let’s go around the group and let everyone give their thoughts about what you’ve decided.”
(c) “The purpose of the group is to provide each of you with a place to discuss the problems of being a teenager with depression with others who also are experiencing a similar situation.”
(d) “You don't have to stay in the group if you don’t want to, but if you choose to leave, then you won’t be able to change your mind later and return to the group.”
Answer:
(c) “The purpose of the group is to provide each of you with a place to discuss the problems of being a teenager with depression with others who also are experiencing a similar situation.”

Explanation:
Focusing on the purpose of the group is the best response. Adolescents are greatly influenced by their peers. Medication alone is not typically the most successful treatment strategy. Questioning whether the client will continue the medication is negative and is not the reason for her to stay in the group.

Asking the rest of the group to respond may or may not give the nurse support for the teenager remaining in the group. Groups commonly have rules regarding movement of members in and out of the group, but this does not address the reasons for the client to remain in the group.

Question 53. 
Which question is most appropriate to use when assessing a 17-year-old client with depression for suicide risk?
(a) “What movies about death have you watched lately?”
(b) “Can you tell me what you think about suicide?”
(c) “Has anyone in your family ever committed suicide?”
(d) “Are you thinking about killing yourself?”
Answer:
(d) “Are you thinking about killing yourself?”

Explanation:
Asking whether the client is thinking about killing himself is the most direct and therefore the best way to assess suicidal risk. Knowing whether the client has watched movies on suicide and death, what the client thinks about suicide, and whether other family members have committed suicide will not tell the nurse whether the client is thinking about committing suicide right now.

Question 54. 
A teacher is talking to the nurse about a child in her classroom who has a tic disorder. The teacher mentions that the boy frequently trips other children although no one has ever been hurt. The teacher then further states that she ignores him when that happens because it is part of his disorder. What should the nurse tell the teacher?
(a) “Tripping other children is not a tic, so you can respond to that as you would in any other child.”
(b) “I can’t believe that you actually allow him to get away with that!”
(c) “I think that’s the best choice unless some parents of the other children start to protest about it.”
(d) “If no one else is getting hurt, then it seems harmless and might prevent the development of a worse behavior.”
Answer:
(a) “Tripping other children is not a tic, so you can respond to that as you would in any other child.”

Explanation:
The teacher needs to be informed that this behavior is inappropriate. Therefore, educating the teacher and encouraging her to respond to misbehavior consistently are correct. Telling the teacher that the nurse cannot believe the teacher lets the child get away with the behavior is demeaning and condescending. Allowing the child to continue the misbehavior is counterproductive to discipline and could create other problems.

Question 55.
A 15-year-old boy being successfully treated for Tourette’s syndrome tells the nurse, “I’m not going to take this medication anymore. Anyone who is really my friend will accept me as I am, tics and all!” What is the nurse’s best response?
(a) “You and your family came to the clinic for treatment, so you can terminate it whenever you wish.”
(b) “Will your lack of medication cause more tics and make you less attractive to girls?”
(c) “Let’s talk about what brought you into treat ment and why you now want to stop taking medication.”
(d) “I think that’s a very unwise decision, but you’re entitled to do whatever you wish.”
Answer:
(c) “Let’s talk about what brought you into treat ment and why you now want to stop taking medication.”

Explanation:
When an adolescent wants to stop treatment with medication, it represents a desire for more control over his/her life as well as a wish to be free of the disorder with which they have been diagnosed. If the caregiver merely acknowledges the client’s right to stop treatment or warns of consequences if the client stops medication, he or she abdicates the adult role of health care advisor.

Before any action is taken, the nurse should explore the client’s reasoning to see if anything in the medication regimen could be changed to make it more palatable for the client. The client also needs to know that if his current objections cannot be overcome, he can return later to restart his medication.

Question 56.    
The nurse is leading a group session for parents of children diagnosed with oppositional defiant disorder. The nurse should give which recommendation for discipline?
(a) Avoid limiting the child’s use of the television and computer for punishment.
(b) Be consistent with discipline while assisting with ways for the child to more positively express anger and frustration.
(c) Use primarily positive reinforcement for good behavior while ignoring any demonstrated bad behavior.
(d) Use time-out as the primary means of punishment for the child regardless of what the child has done.
Answer:
(b) Be consistent with discipline while assisting with ways for the child to more positively express anger and frustration.

Explanation:
Consistent discipline and alternative methods of anger management are two important tools for parents who have a child with oppositional defiant disorder. Consistent discipline sets limits for the child. Helping the child learn more appropriate ways to manage anger assists the child in living within societal expectations.

Avoiding restriction of television and computer time for punishment or using time-out as the primary means of punishment has not been suggested as an appropriate management method. Typically, using many strategies is more effective. Ignoring bad behavior could be dangerous and does not reinforce to the child that limits on behavior exist in society.

Question 57.    
An adolescent client is sent to the school clinic with dizziness and nausea. While assessing the girl, who denies any health problems, the nurse smells alcohol on her breath. Which response by the nurse is most appropriate?
(a) “Don’t tell me that you have been drinking alcohol before you came to school this morning”
(b) “What is the real reason that you are feeling sick this morning?”
(c) “Tell me everything that you have had to eat and drink yesterday and today.”
(d) “I know that high school stressful, but drinking alcohol is not the best way to handle it.”
Answer:
(c) “Tell me everything that you have had to eat and drink yesterday and today.”

Explanation:
Asking the client to report everything that she has had to eat and drink yesterday and today is the least judgmental approach and also provides helpful information. Confronting the client about drinking alcohol or asking her to admit the real reason for feeling sick can put the client on the defensive and block further communication. The nurse should avoid putting the client on the defensive to facilitate communication that may eventually enable the nurse to get the truth and identify interventions.

Question 58.    
A school-age child was recently hospitalized at a child psychiatric unit for inattention and acting out behavior at school and home. His provider prescribed the methylphenidate patch to control his attention deficit hyperactivity disorder symptoms, and inpatient unit staff worked with him on behavioral control measures. During his first office visit after his discharge from the hospital, the office nurse discovers that the boy has been taking off his patch during the day, which is causing problems at school and at home. In which order of priority from first to last should the nurse take the actions? All options must be used.
(a) Explain to the family, in terms the child can understand, the benefits of his medication in dealing with school and home problems he is experiencing.
(b) Explore the parents’ attitudes about medication administration in general and their child’s medication in particular.
(c) Explore the child’s reasons for removing the patch during the day rather than at the end of the day.
(d) Have the provider discuss with the child and parents a trial of a different medication.
Answer:
(c) Explore the child’s reasons for removing the patch during the day rather than at the end of the day.
(b) Explore the parents’ attitudes about medication administration in general and their child’s medication in particular.
(a) Explain to the family, in terms the child can understand, the benefits of his medication in dealing with school and home problems he is experiencing.
(d) Have the provider discuss with the child and parents a trial of a different medication.

Explanation:
(c), (b), (a), (d) First, the child’s reasons for removing the patch need to be explored to determine what needs to be done to solve the problem of inadequate medication administration. Since the child is probably heavily influenced by his parents’ attitudes about taking medications, their attitudes need to be addressed next to determine if they openly or subtly oppose the medication or its method of administration.

Once the knowledge of the child’s and parent’s feelings about medication are known, education can be offered to be sure the child understands how the medication can help him cope better in school and home. If the child continues to take off his patch or demonstrates an allergic response to the patch, or if it is determined that his parents are not supportive of the patch, discussion of a trial of another medication to treat the child’s symptoms should occur.

Question 59. 
A school-age client is diagnosed with conduct disorder. After admission, the nurse identifies his problematic behaviors as cruelty to animals, stealing, truancy, aggression with peers, lying, and explosive angry outbursts resulting in destruction of property. The nurse is now talking with the client about his behavioral contract, which should include which crucial components? Select all that apply.
(a) taking prescribed medications
(b) acceptable methods for expressing anger
(c) consequences for unacceptable behaviors
(d) rules for interacting with staff and other clients
(e) personal possessions allowed on the unit
Answer:
(a) taking prescribed medications
(b) acceptable methods for expressing anger
(c) consequences for unacceptable behaviors

Explanation:
(a), (c), (b) The crucial elements of a behavioral contract include compliance with the medication regimen if medication is prescribed, appropriate anger management, consequences for unacceptable behaviors, and rules for interactions with others. Personal possessions may be limited by unit rules but are not part of an individualized behavioral contract
 
Question 60. 
The nurse is meeting weekly with an adolescent recently diagnosed with depression to monitor progress with therapy and antidepressant medication. The nurse should be most concerned when the client reports what information?
(a) An acquaintance hanged herself 2 days ago.
(b) She is experiencing intermittent headaches as a side effect of taking the antidepressant.
(c) She received a low score on her last history test.
(d) Her younger brother has been starting fights with her for the last week.
Answer:
(a) An acquaintance hanged herself 2 days ago.

Explanation:
While all the occurrences could upset the client in the early stage of treatment, the one involving the most risk to safety is the suicide completion of a peer. Adolescents are susceptible to “copycat” suicides. The fact that she knows the method of suicide of the acquaintance and is at a critical period in treatment, when her antidepressant may have given her increased energy while still experiencing low self-esteem, can put her at significant risk for suicide.

Question 61. 
A 19-year-old male with cystic fibrosis (CF) is hospitalized for a serious lung infection and is in need of a lung transplant. However, he has a rare blood type that complicates the process of obtaining a donor organ. He has also been diagnosed with bipolar disorder and treated successfully since mid-adolescence with medication and therapy. The client requests to see a chaplain to help him make plans for a funeral and donation of his body to science after death. How should the nurse interpret the client’s request?
(a) It is a signal of the depressive side of his bipolar disorder, and he should be checked for suicidal thoughts/plans.
(b) It is a signal of an exacerbation of the client’s CF and warrants further assessment by his lung specialist.
(c) It is a signal of the client’s awareness he is likely to have a shortened life span and should be supported by unit staff.
(d) It is a signal of delirium as a result of the many medications he is taking and requires further assessment by the pharmacist or health care provider (HCP).
Answer:
(c) It is a signal of the client’s awareness he is likely to have a shortened life span and should be supported by unit staff.

Explanation:
A client who has endured serious chronic illness (both psychiatric and medical) would be well aware of his shortened life span, particularly if he is unable to get a lung transplant. It would not be unusual for him to want to plan ahead so his wishes would be honored in the event of his death. In the absence of other physical signs, an exacerbation of CF or delirium is not demonstrated.

Likewise, his successful bipolar treatment in the absence of any other signs rules depression out as a reason for his behavior. Though it may be difficult to think about a young person in terms of dying, the client’s consid-eration of the future is a rational decision.

Question 62. 
A 6-year-old boy has experienced the death of his mother in the last 3 months. He and his father are involved in a grief support program that has sessions for all ages. A nurse is educating the parents in the group about the normal grief reactions of children to help them distinguish normal behavior from behavior that is unusual and possibly indicative of depression or other psychological issues. Which represents normal grief behavior for this young child after the death of his mother? Select all that apply.
(a) talking to his mother as if she were present in the room
(b) crying followed in a few minutes by laughing
(c) playing with a rope, saying he is going to be with his mother
(d) yelling and being angry at his mother for leaving him
(d) playing with a friend right after saying he misses his mother.
Answer:
(a) talking to his mother as if she were present in the room
(b) crying followed in a few minutes by laughing
(c) playing with a rope, saying he is going to be with his mother
(d) yelling and being angry at his mother for leaving him

Explanation:
(a), (b), (c), (d) Young children cannot be sad all the time after a loss, but that does not mean they grieve less. Their moods change more quickly, and they often work out their issues through play rather than talking. Because young children do not have a full understanding of death’s finality, they may talk to a deceased loved one as if they are present.

They also may not understand the circumstances of the death and so may think the loved one left voluntarily and be angry at the deceased for leaving them. Play involving a dangerous object such as a rope, coupled with a stated desire to join the deceased parent, would be cause for alarm as the child could harm himself either purposely or accidentally.

Question 63. 
When counseling a 5-year-old girl who recently suffered the loss of her mother, which statement reflects the typical understanding about death at this age?
(a) “My mommy died last week, but I’m going to see her again.”
(b) “My daddy said mommy went to heaven, and I’m glad God took her there.”
(c) “My dog died and now we got another one.”
(d) “I think Mommy went to heaven and I will get to see her someday when I die.”
Answer:
(a) “My mommy died last week, but I’m going to see her again.”

Explanation:
Five-year-old children view death as reversible, so talking about seeing her mother again is a normal statement for a child of this age. A child of this age would not usually state that she was glad Jesus took her mom but instead might be afraid that God would also take her or her dad. The idea of replacing her mother with a new one, as hinted in the statement that they got another dog after the dog died, has not been supported by studies of grieving children. Stating that mommy went to heaven and that the child will see her someday when the child dies is reflective of more advanced abstract thinking than a 5-year-old would demonstrate.

Question 64. 
A shy 12-year-old girl who must change school systems just before she begins junior high school begins cutting her arms to relieve the stress that she feels about leaving long-standing friends, having to develop new friendships, and meeting high academic standards in her new school. After she has been cutting for a few weeks, her parent discovers the injuries and takes her to a psychiatrist mental health provider who prescribes a therapeutic group at the local mental health center and medication to help decrease her anxiety. Which findings indicate that the girl had made appropriate progress toward recovery? Select all that apply.
(a) The girl indicated that she had joined three clubs at school and agreed to be an officer in one of them.
(b) The girl says she has developed a friendship with a girl in her class and one in her therapy group.
(c) The girl wears short-sleeved and/or sleeveless tops when the weather is warm.
(d) The girl’s grades are good, and her hours of study are not excessive.
(e) The girl begins saying she must study hard so she can get into a good university.
Answer:
(b) The girl says she has developed a friendship with a girl in her class and one in her therapy group.
(c) The girl wears short-sleeved and/or sleeveless tops when the weather is warm.
(d) The girl’s grades are good, and her hours of study are not excessive.

Explanation:
(b), (c), (d) The development of friendships and good grades with moderate amounts of study are positive signs since friends and grades in the new school were sources of stress and anxiety for the girl. The ability to wear clothes appropriate to the weather rather than hiding her arms is a sign she is no longer injuring her arms. Joining three clubs and being an officer in one of them is unlikely and would probably be an additional source of stress for the girl as would be pushing herself to extraordinary academic achievement to secure a place in college when she has just entered junior high.

Question 65. 
The parents of a preschool-age child diagnosed with autism must take their child on a plane flight and are concerned about how they can make the experience less stressful for her and their fellow travelers. The nurse suggests a dry run to the airport in which they simulate going through security and boarding a plane. In addition, the nurse suggests taking items to help the child be calm during the flight. In what order of priority from first to last should the parents employ the items listed below? All options must be used.
(a) a DVD player with headphones and favorite games, cartoons, and child films
(b) a favorite stuffed toy animal or other soft toy
(c) a favorite nonelectronic game
(d) medication that can be given as needed to calm the child
Answer:
(a) a DVD player with headphones and favorite games, cartoons, and child films
(c) a favorite nonelectronic game
(b) a favorite stuffed toy animal or other soft toy
(d) medication that can be given as needed to calm the child

Explanation:
(a), (c), (b), (d) Electronic games and stories are favorites of most children but are particularly enjoyed by children on the autism spectrum. The headphones block out some of the noises that might be upsetting to a child on the autism spectrum. If the child cannot be engaged electronically, a favorite nonelectronic toy would be the next choice. Stuffed animals or other soft toys can soothe a child who is starting to become upset. Medication should be a last resort as it can have a paradoxical effect if it is an antianxiety medication or may cause too much sedation during the flight.

Question 66. 
A nurse is conducting a group session for parents of toddlers recently diagnosed with autism. Which parent statement indicates a need for additional teaching?
(a) “Children with autism may develop normally until 18 to 24 months old.”
(b) “Children with autism may have poor coordination of the large muscles.”
(c) “Children with autism may be extremely sensitive to sounds and smells.”
(d) “Children with autism may be overwhelmed by rules and structure.”
Answer:
(d) “Children with autism may be overwhelmed by rules and structure.”

Explanation:
Children with autism spectrum disorder tend to function best with clear rules, routine and daily structure. Children with autism may develop normally until 18 to 24 months old at which time their development may be stifled or they may regress. Many people with autism have difficulty with muscle tone and coordination, which can affect their ability to reach developmental milestones. Children with autism often have sensory dysfunction and are extremely sensitive to sounds, smells, textures, and tastes.

Question 67. 
Which interventions should the nurse include in the plan of care for a school-age child with autism who has been admitted to the hospital? Select all that apply.
(a) Allow a family member in the room twenty-four hours a day.
(b) Limit the number of health care providers and nurses interacting with the child.
(c) Encourage the child to alert his nurse when ever he is in pain.
(d) Dim lights and keep noise levels low.
(e) Show medical equipment to the child before procedures.
(f) Bring in possessions from home. 
Answer:
(a) Allow a family member in the room twenty-four hours a day.
(c) Encourage the child to alert his nurse when ever he is in pain.
(d) Dim lights and keep noise levels low.
(e) Show medical equipment to the child before procedures.

Explanation:
(a), (c), (d), (e) Children with autism prefer routine and familiarity. Having a family member in the room 24 hours a day may decrease the child’s anxiety. Limiting the number of different health care providers (HCP) Q and nurses that interact with the child may also help reduce anxiety. Dimming lights and keeping noise levels low will reduce sensory stimulation.

Introducing autistic children to equip-ment prior to a procedure may help reduce their anxiety. Bringing in possessions from home will help with routine and familiarity. People with autism often have a limited ability to communicate. Health care providers need to approach autistic children carefully with minimal touch and clear and concise instructions; their interactions should be brief.

Question 68.
A parent brings their adolescent with autism to the emergency department with a bleeding forehead laceration resulting from head banging. What order should the nurse perform the actions from first to last? All options must be used.
(a) Ensure constant observation.
(b) Assess the head laceration.
(c) Provide education on self-harming behavior.
(d) Recommend a head computed tomography scan.
Answer:
(a) Ensure constant observation.
(c) Provide education on self-harming behavior.
(b) Assess the head laceration.
(d) Recommend a head computed tomography scan.

Explanation:
 (a), (c), (b), (d) The nurse first assesses and treats the bleeding head laceration. Next, the nurse assures that the parent or a staff member remains with the child to ensure that the child does not engage in additional self-harming behaviors. Next, the nurse makes a recommendation to the provider for a computed tomography scan to determine if there is any additional injury to the brain or skull. Finally, the nurse provides the parent with education on self- harming behaviors.

Question 69. 
The nurse is assessing a 7-month-old infant. Which assessment findings require further evaluation for autism? Select all that apply.
(a) no babbling or pointing by one year of age
(b) poor eye contact
(c) only responds to name when spoken by parent
(d) absence of social play
(e) no social smile
(f) fixation on objects
Answer:
(a) no babbling or pointing by one year of age
(b) poor eye contact
(e) no social smile
(f) fixation on objects

Explanation:
(a), (b), (e), (f) Symptoms of autism are often unrecognized during infancy. Autistic behaviors can be recognized as early as six months of age and include: no babbling or pointing by one year of age, poor eye contact, lack of a social smile, and fixation on objects rather than people. Children with autism rarely respond to their name regardless of who is attempting to get their attention. All infants lack social play

Question 70.    
The parent of a school-age child with autism asks the nurse how she should tell her son that he has autism. Which response by the nurse is most therapeutic?
(a) “Explain to your son that he has a developmental disorder that makes him different from other children his age.”
(b) “You should let the health care professionals tell your son about his diagnosis of autism.”
(c) “Tell your son that he is different from other kids his age and that you will always be there to support him.”
(d) “Explain the definition of autism and empha size your child’s strengths as well as his areas of challenge.”
Answer:
(d) “Explain the definition of autism and empha size your child’s strengths as well as his areas of challenge.”

Explanation:
Using age-appropriate terminology, parents should explain the definition of autism to their child focusing on the child’s individual strengths and challenges. Providing examples of the child’s strengths and challenges and comparing them to the strengths and challenges of other children can assist the child in understanding how he or he is different from others. 

A 9-year-old will not understand the definition of a developmental disorder. Autistic children prefer familiarity; therefore, it is not advised to have a health care professional explain the diagnosis of autism. It is important for parents to let their autistic child know that they will support the child, but they should explain the diagnosis of autism.

Question 71.    
A 5-year-old child with autism has been diagnosed with the eating disorder pica. When educating the family about pica, which information should the nurse include?
(a) Pica will improve as the child gets older.
(b) The child will require periodic lead screening.
(c) Avoid feeding the child foods high in zinc.
(d) The child will require periodic abdominal X-rays.
Answer:
(b) The child will require periodic lead screening.

Explanation:
Children with PICA often ingest substances that contain toxic ingredients like lead. Periodic blood lead levels will indicate if the child is at risk for lead poisoning. PICA usually improves as kids get older. However, in children with autism PICA is often an ongoing problem. Providing a balanced nutrition and addressing nutritional deficiencies are essential for a child with PICA. There is no need to avoid zinc. Children with PICA may need an abdominal X-ray if there is a suspected abdominal obstruction, but periodic scheduled x-rays are not necessary.

Question 72.
The parent of a child with autism tells the nurse that her child is only sleeping 2 to 3 hours per night. When educating the parent about treatment for the child’s sleep disturbance, the nurse should include what information?
(a) Behavioral interventions including sleep-hygiene measures are often effective in treating sleep disturbance.
(b) Exercising before bed will tire the child and promote quality sleep.
(c) Complete elimination of caffeine from the child’s diet will effectively treat the sleep disturbance.
(d) Zolpidem given each night one hour before bed will help promote quality sleep.
Answer:
(a) Behavioral interventions including sleep-hygiene measures are often effective in treating sleep disturbance.

Explanation:
Behavioral interventions have been found to be effective in treating sleep disturbances in children with autism. Exercising 20 to 30 minutes a day can aid in promoting health but children should not exercise within a few hours of going to bed or it may cause additional sleep disturbances.

While restricting caffeine within a few hours of bed may help promote sleep, completely eliminating caffeine from a child’s diet may be extremely difficult. Medication is not often recommended to treat sleep disorders in autistic children and can be habit-forming. Zolpidem is a sedative used to treat insomnia, but it is not recommended for children.

Question 73.    
The parent of an autistic child visits the clinic and tells the nurse that her child has been acting out in school, particularly in the cafeteria and during gym class. Understanding that the child may be having difficulty with sensory processing, the nurse should suggest that the health care provider refer the child to which professional?
(a) physical therapist
(b) mental health provider 
(c) occupational therapist
(d) speech language pathologist
Answer:
(c) occupational therapist

Explanation:
Occupational therapists can help evaluate sensory processing issues and fine motor difficulties. Many occupational therapists are also trained in coping strategies to help individuals feel more comfortable in their surroundings. Physical therapists primarily work on gross motor skills, often working closely with occupational therapy to develop effective exercise programs for autistic clients.

A mental health provider will help the child and family man-age emotional and mental health concerns. Speech language pathologists evaluate communication deficits and assist clients in developing functional communication skills.

Question 74. 
A 6-year-old child with autism has been prescribed risperidone to treat aggression and self-injury behaviors. When educating the family about risperidone, the nurse should include which information?
(a) Notify the child’s health care provider if a dose of risperidone is missed.
(b) Notify the child’s health care provider if the child is exhibiting lip smacking behaviors.
(c) The child may experience weight loss after beginning risperidone.
(d) The child will have improved behavior about one week after starting risperidone.
Answer:
(b) Notify the child’s health care provider if the child is exhibiting lip smacking behaviors.

Explanation:
Notify the health care provider if the child exhibits lip smacking behavior as it may be an indication that the child is developing tardive dyskinesia. If the child misses a dose of risperidone, give the missed dose as soon as possible. If it is near the next scheduled dose, skip the missed dose. Weight gain is a common side effect of risperidone. It takes about 3 to 4 weeks of treatment with risperidone to see major changes in behavior.

Question 75.
Which child would the nurse identify as being most at risk for an episode of major depression?
(a) a 16-year-old male who has been struggling in school, earning only Cs and Ds
(b) a 13-year-old female who was upset over not being chosen as a cheerleader
(c) a 10-year-old male who has never liked school and has few friends 
(d) a 14-year-old female who recently moved to a new school after her parents’ divorce
Answer:
(d) a 14-year-old female who recently moved to a new school after her parents’ divorce

Explanation:
Children who experience serious losses, especially multiple losses, such as old friends or a parent, are more at risk for depression. Girls also are at greater risk than boys during the adolescent years. While doing poorly in school is a risk factor for depression, it is not as great as having two sudden losses. Being upset over not being selected over being a cheerleader indicates represents a loss, but not multiple or serious losses. Not doing well in  school is a risk, but developing new friends shows a positive perspective.

Question 76. 
A nurse on the mental health unit tells the nurse manager, “Kids with conduct disorders might as well be jailed because they all end up as adults with antisocial personality disorder anyway.” What is the best reply by the nurse manager?
(a) “You really sound burned out. Do you have a vacation coming up soon?”
(b) “These children are more likely to have problems with depression and anxiety disorder as adults.”
(c) “You sound really frustrated. Let’s talk about the meaning of their behavior.”
(d) “My experience hasn’t been that negative. Let’s see what the other staff members think; maybe I’m wrong.”
Answer:
(c) “You sound really frustrated. Let’s talk about the meaning of their behavior.”

Explanation:
The nurse manager needs to focus on the frustration that the nurse is expressing. Additionally, the nurse manager needs to correct any misinformation or misinterpretation that the staff nurse has. Saying that the nurse sounds burned out and asking about a vacation do not focus on the nurse’s frustration or address the inaccuracy of the nurse’s statement.

There is no evidence to suggest that children with conduct disorder have more than the average adult’s risk of depression or anxiety. Therefore, this response is inaccurate and inappropriate. Anecdotal information from personal experience does not supply the nurse with accurate, reliable information.

Question 77. 
Which child would the nurse assess as dem-onstrating behaviors that need further evaluation?
(a) a 2-year old who refuses to be toilet trained and talks to himself
(b) a 6-year-old who sucks her thumb when tired and has never spent the night with a friend
(c) a 10-year-old who frequently tells his mother that he is going to run away whenever they argue
(d) a 2-year-old who is indifferent to other children and adults and is mute
Answer:
(d) a 2-year-old who is indifferent to other children and adults and is mute

Explanation:
Indifference to other people and mutism may be indicators of autism and would require further investigation. A 2-year-old who talks to himself and refuses to cooperate with toilet training is displaying behaviors typical for this age. Occasional thumb sucking and not having spent the night with a friend would be normal at age 6. Threatening to run away when angry is considered within the range of normal behaviors for a 10-year-old child.

Question 78.
A nurse has been caring for an adolescent client in a residential facility. The child has been through a series of foster placements since infancy with no success in any placement until the age of 7 when placed with a middle-aged single woman. The client thrived there until the woman was killed in a car accident. The client attempted suicide after her foster mother died in response to the loss, and the child was placed in the residential facility. The nurse has become close to this client and wants to help her address her issues and move on with her life. Which comment to the manager demonstrates that the nurse understands the client’s issues and is able to respond appropriately to the client’s needs?
(a) “It’s difficult for her to love and trust again after her losses. In this facility, she can learn to deal with her loss in a less emotionally charged environment than a foster home.”
(b) “She just needs someone who will love her and give her the things she has missed out on in life. An adoptive family needs to be found for her as soon as possible.”
(c) “I’m not sure she’s going to be able to get past all the loss and rejection she has experienced. I don't think adoption will ever be a viable option for her.”
(d) “I know her well and am familiar with her issues. I think the best chance for success for her would be if she was adopted into my family.”
Answer:
(a) “It’s difficult for her to love and trust again after her losses. In this facility, she can learn to deal with her loss in a less emotionally charged environment than a foster home.”

Explanation:
The severe emotional trauma the girl has experienced will likely make it difficult for her to be successful in an adoptive placement at the present time, whether that placement is with someone she knows [the nurse) or another adoptive family. Additionally, adoption by the nurse is inappropriate because it blurs the lines between her professional and personal life and is likely to confuse the client.

It is clear that the client has many issues and that love alone is not likely to solve all her problems. Treatment at the residential facility will allow her to work through emotional issues in a more therapeutic environment. Though not currently ready for adoption, she may be ready for adoption in the future after sufficient treatment.

Question 79.
Which adolescent would the nurse determine needs further evaluation?
(a) a young adolescent girl whose mood changes when upset with her parents, though she has never been in trouble in school or the community
(b) a young adolescent boy who coughs for 5 minutes after trying his first marijuana cigarette and declares he does not want to do it again
(c) a young adolescent boy who restricts his food and fluid intake in order to be able to box in a lower weight class
(d) a young adolescent girl who reads “dark” novels and questions why God allows innocent people to be harmed
Answer:
(c) a young adolescent boy who restricts his food and fluid intake in order to be able to box in a lower weight class

Explanation:
Restricting intake to lose weight is a first step toward an eating disorder for males as well as females, so this behavior should be investigated further, especially since males of this age are usually unconcerned about their weight. Quick mood  changes are common in young adolescents, particularly girls. Such mood changes should not be considered problematic if the adolescent is not experiencing trouble in major areas of his/her life. 

Experimenting with alcohol or other substances is fairly common in the teen years, but one or two uses do not generally lead to addiction. The negative effect of the coughing may be a deterrent to further use. Religious questioning and exploration of “dark” subjects is common among teens and is part of the development of mature thinking. In the absence of other signs of depression, it does not warrant further evaluation.

Question 80. 
A new client has just been admitted to an adolescent psychiatric inpatient unit. The charge nurse and an unlicensed assistive personnel (UAP) are discussing the client’s needs. The UAP says,
“She is just showing off to try and get our sympathy. There is no need for her to cut herself. Why would adolescents want to do such a thing to themselves?” What response by the charge nurse would most help the UAP understand the client and her illness?
(a) “She’s not doing the cutting for attention since she always wears clothing that covers up her injuries, and further, she’s not willing to talk about it.”
(b) “It’s hard to see a young person harm herself as she does, but she has serious family issues and doesn’t know better ways to handle them, so we have to help her with that.”
(c) “You don’t understand her problems and don’t take them seriously, so you shouldn’t be allowed to work with her during her hospitalization.”
(d) “Perhaps you should transfer to another unit where you are able to have empathy for the clients.”
Answer:
(b) “It’s hard to see a young person harm herself as she does, but she has serious family issues and doesn’t know better ways to handle them, so we have to help her with that.”

Explanation:
The IUAPQ is concerned about the behavior of the client and confused about why it is occurring, so the nurse needs to explain a bit about the issues involved as well as demonstrate empathy for the aide. It is appropriate to explain that the client is not cutting for attention, but the nurse’s response does not address the reason for the teen’s behavior and is therefore inadequate.

It could also appear that the nurse is denigrating the UAP, which will not encourage the aide to listen to what she has to say. The comments that the UAP cannot work with the client or that she should transfer are punitive and do nothing to help the UAP understand self-mutilation.

Question 81. 
A teenage client is admitted to the psychiatric unit with both bulimia nervosa and anorexia nervosa. Which initial interventions are appropriate for this client? Select all that apply.
(a) Assign a staff member to accompany the client when using the bathroom.
(b) Have the client keep a self-monitoring journal as a coping strategy.
(c) Weigh the client in same amount of clothing and facing away from scale at daily scheduled intervals.
(d) Inform the client that parenteral nutrition will be necessary if the client does not gain weight.
(e) Assign a staff member to sit with client during meals and for IV2 hours after meals.
(f) Provide liquid protein supplements when client is unable to eat meals. 
Answer:
(a) Assign a staff member to accompany the client when using the bathroom.
(b) Have the client keep a self-monitoring journal as a coping strategy.
(c) Weigh the client in same amount of clothing and facing away from scale at daily scheduled intervals.
(e) Assign a staff member to sit with client during meals and for IV2 hours after meals.
(f) Provide liquid protein supplements when client is unable to eat meals. 

Explanation:
(a), (b), (c), (e), (f) Interventions for the client with both bulimia nervosa and anorexia nervosa involve assigning a staff member to accompany the client to the bathroom; promoting a self-monitoring journal as a nonfood coping strategy; providing daily weight measurement in the same clothing at the same times of the week, while facing the client away from the scale readout; assigning a staff member to sit with the client during meals and stay with the client for IV2 hour after meals; and providing liquid protein supplements when the client is unable to eat meals. Telling the client that parenteral nutrition will be necessary may be perceived as a threat and is not an appropriate initial intervention.

Question 82. 
A young adult female who was admitted to the psychiatric hospital 2 months ago with an eating disorder is being discharged. Which action indicates the client understands discharge instructions?
(a) The client returns to the same living situation as she had prior to hospitalization.
(b) The client attends a social club at her local church.
(c) The client returns to the lab for routine lab tests.
(d) The client enrolls in a health club.
Answer:
(c) The client returns to the lab for routine lab tests.

Explanation:
The client with an eating disorder is instructed to receive regular lab tests to monitor nutritional compliance. Frequently, the living situation from before hospitalization was dysfunctional, and returning to the situation can result in recurrent health problems. Attending a social club is not a priority for the client, and enrolling in a health club could result in the client exercising excessively.

Mental Health disturbance shows the following changes like stress, overthinking, hallucination of small things etc.