Chapter 03: Ethical and Legal Issues
Morrison-Valfre: Foundations of Mental Health Care, 6th Edition
MULTIPLE CHOICE
- A male teenage client tells the nurse that his friends like to drink alcohol occasionally to get drunk. The client’s friends see nothing wrong with their drinking habits. The client states that he was taught by his parents and agrees that underage drinking is not acceptable. Also, he has never seen his parents drunk; therefore, he refuses to drink with his friends. Which mode of transmission best describes how this client’s particular value was formed?
| a. | Moralizing |
| b. | Modeling |
| c. | Reward-punishment |
| d. | Laissez-faire |
ANS: B
Modeling best describes how the teenage client developed this value because his parents not only discussed this issue but behaved in a way for the teen to copy. Moralizing sets standards of right and wrong with no choices allowed; the reward-punishment model rewards valued behavior and punishes undesired behavior; and the laissez-faire model imposes no restriction or direction on choices.
PTS: 1 DIF: Cognitive Level: Application REF: p. 21
OBJ: 1 TOP: Acquiring Values
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
- A female client becomes combative when the nurse attempts to administer routine medications. The nurse would like to ignore the client but chooses to talk with the client to calm her. The nurse is successful in calming the client, and the client takes her medications. What process best describes how the nurse decided on the course of action taken?
| a. | Values clarification |
| b. | Nurse’s rights |
| c. | Beliefs |
| d. | Morals |
ANS: A
Values clarification consists of the steps of choosing, prizing, and acting. This most accurately describes how the nurse made the proper decision. The nurse chose the best action, reaffirmed the choice, and then enacted the choice. The nurse’s rights were not violated, and beliefs and morals do not describe the entire decision-making process that occurred.
PTS: 1 DIF: Cognitive Level: Application REF: p. 21
OBJ: 1 TOP: Values Clarification
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- Twenty-three states have enacted mental health parity laws. The most accurate description of these laws is that they require insurance companies to:
| a. | Include coverage for mental illness |
| b. | Include coverage for substance abuse treatment |
| c. | Include coverage for mental illness that is equal to coverage for physical illness |
| d. | Include coverage for outpatient therapy for individuals with substance abuse |
ANS: C
The mental health parity laws require insurance companies to include coverage for mental illness that is equal to coverage for physical illness. Only nine states include treatment for substance abuse in their parity laws.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 22
OBJ: 2 TOP: Client Rights
KEY: Nursing Process Step: Assessment
MSC: Client Needs: Safe and Effective Care Environment
- The client is feeling very anxious and has requested that a p.r.n. antianxiety medication be ordered. The nurse informs the client that the medication can be administered only every 4 hours and was given 3 hours ago. The nurse promises to give the client the medication as soon as it is due, but the nurse goes to lunch 1 hour later without giving the client the medication. Which ethical principle did the nurse violate?
| a. | Fidelity |
| b. | Veracity |
| c. | Confidentiality |
| d. | Justice |
ANS: A
Fidelity refers to the obligation to keep one’s word. The nurse violated this principle in this situation, which leads to mistrust from the client. Veracity is the duty to tell the truth, confidentiality is the duty of keeping the client’s information private, and justice indicates that all clients must be treated fairly, equally, and respectfully.
PTS: 1 DIF: Cognitive Level: Application REF: p. 23
OBJ: 3 TOP: Ethical Principles
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- A male client is seeking help in a mental health clinic for anger management problems. He voices that he is fearful that his wife may divorce him because of his anger problem, and he is willing to do “whatever it takes” to control his anger. Later in the week, the client’s wife also seeks assistance because she is going to divorce her husband. The nurse who is caring for both of these clients tries to decide the correct action to take. The nurse is experiencing:
| a. | A moral dilemma |
| b. | Value clarification |
| c. | An ethical conflict (or dilemma) |
| d. | A breach of confidentiality |
ANS: C
This is an example of an ethical conflict or ethical dilemma. The nurse wants to help both clients but must maintain confidentiality for each. Use of guidelines for ethical decision making can assist the nurse in making an ethical decision. A moral dilemma is simply a dilemma associated with making a decision between right and wrong. Value clarification is a process that helps to identify an individual’s values.
PTS: 1 DIF: Cognitive Level: Application REF: p. 23
OBJ: 3 TOP: Ethical Conflict
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- The psychiatrist asks the nurse to perform a procedure that she is not familiar with, and the nurse is unsure whether this is something within the scope of practice. Where can the nurse find the answer to her question?
| a. | National nurse practice act |
| b. | State nurse practice act |
| c. | Regional nurse practice act |
| d. | Community nurse practice act |
ANS: B
Each state’s board of nursing determines the scope of practice in that state through a series of regulations that are called nurse practice acts. It is the nurse’s responsibility to know his or her scope of practice. The other options do not exist.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 25
OBJ: 4 TOP: Legal Concepts in Health Care
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- An order written by a physician is reviewed by the nursing staff, and no one is familiar with the treatment instructions. A nurse who was recently hired knows that this treatment is covered by the state’s nurse practice act. What is the nurse’s best course of action?
| a. | Call the physician to ask for clarification |
| b. | Check the state’s nurse practice act again |
| c. | Contact the nursing supervisor for approval to carry out the treatment |
| d. | Refer to the facility’s policy and procedure to determine the course of action |
ANS: D
Because this treatment is covered under the state’s nurse practice act, the next step is to refer to the facility’s policy and procedure manual to determine whether the ordered treatment is allowed by the facility. Calling the physician is not necessary because there was no question about how the order was written, and the state’s nurse practice act has already been checked. Contacting the nursing supervisor would be acceptable only after the facility’s policy has been checked.
PTS: 1 DIF: Cognitive Level: Application REF: p. 25
OBJ: 4 TOP: Legal Concepts in Health Care
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- Standards of nursing practice for mental health can best be described as helping to ensure:
| a. | That certain clients receive care |
| b. | Quality and effectiveness of care |
| c. | Proper documentation |
| d. | Proper medication administration |
ANS: B
Most health care disciplines have standards of practice documented as guidelines with measurable criteria that can be used to evaluate the quality and effectiveness of care provided. All clients have the right to receive care, so standards of nursing practice would not address who receives care. Although proper documentation and proper medication administration might be part of the evaluation process, they do not provide complete evaluation of quality and effectiveness of care.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 25
OBJ: 4 TOP: Legal Concepts in Health Care
KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Safe and Effective Care Environment
- If a client is involuntarily committed to a mental health care facility indefinitely, the law requires that the case must be reviewed every:
| a. | 3 months |
| b. | 6 months |
| c. | 12 months |
| d. | 15 months |
ANS: C
Although the case is being reviewed constantly by the mental health care team, the court must review the indefinite commitment on a yearly basis.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 26
OBJ: 5 TOP: Adult Psychiatric Admissions
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- A male client is being argumentative during a group therapy session. The psychiatric technician warns the client that if he does not cooperate with the nurse, he will be physically restrained and taken to his room for the remainder of the day. For which action could the technician be held liable?
| a. | Assault |
| b. | Battery |
| c. | Privacy |
| d. | Fraud |
ANS: A
The technician is engaging in assault, which is any act that threatens a client. Battery of a client occurs when any physical act of touching occurs without the client’s permission. Privacy refers to issues related to the body and confidentiality, and fraud is giving false information.
PTS: 1 DIF: Cognitive Level: Application REF: p. 26
OBJ: 6 TOP: Areas of Potential Liability
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- Which of the following circumstances, when it occurs on an inpatient mental health unit, would be considered false imprisonment?
| a. | An alert and oriented client is confined to his room after being loud and argumentative with another client in the recreation area. |
| b. | Restraints are placed on a client who has been admitted in a lethargic state because of misuse of medications and who has fallen three times since admission. |
| c. | A client is housed in a private room with visual monitors after attempting suicide at home on the previous day. |
| d. | An alert and oriented client who was admitted for a 72-hour involuntary commitment is prevented from leaving the facility 2 days after admission. |
ANS: A
The client cannot be confined to his room if he did not pose a threat to himself or others, or if no contract was made with the client regarding consequences for inappropriate behavior. All of the other options are appropriate because they follow guidelines for client safety.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 27
OBJ: 6 TOP: Areas of Potential Liability
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- The nurse often assists in the process of obtaining informed consent from the client for treatment and/or procedures. Who has the responsibility of providing information to the client so he can give informed consent?
| a. | Social worker |
| b. | Nurse |
| c. | Physician |
| d. | Facility’s legal representative |
ANS: C
The physician is responsible for providing the client with the information necessary to give informed consent, including expectations and risks involved. The nurse can assist by obtaining the written documentation necessary for informed consent.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 27
OBJ: 8 TOP: Care Providers’ Responsibilities
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- An important responsibility of the nurse in a mental health facility is to ensure that clients do not __________ from the facility without a discharge order, by carefully supervising and accurately documenting client behaviors and therapeutic actions.
| a. | Escape |
| b. | Abandon |
| c. | Flee |
| d. | Elope |
ANS: D
The appropriate terminology used when a client runs away from a facility without a discharge order is elopement. In the event of elopement, the caregiver can be held liable if a client becomes injured.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 27
OBJ: 8 TOP: Care Providers’ Responsibilities
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- If a female client tells the nurse of extensive plans she has to harm the girlfriend of her ex-husband, what is the nurse’s best action?
| a. | Try to talk with the client to convince her not to harm the girlfriend |
| b. | Have the client sign a contract with you stating that she will not harm the girlfriend |
| c. | Inform the ex-husband of the intentions of the client |
| d. | Inform the girlfriend of the intentions of the client |
ANS: D
Health care providers have a duty to warn others when serious harm may occur as the result of actions taken by the client. This does not breach confidentiality because providers have an obligation to protect the public as well as the client. In addition to warning the client, the nurse should inform the client’s physician and the nursing supervisor and must document the situation and actions taken. The other options are not adequate to meet the duty to warn or to prevent harm to the girlfriend.
PTS: 1 DIF: Cognitive Level: Application REF: p. 27
OBJ: 8 TOP: Care Providers’ Responsibilities
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- A female client asks the nurse if the medication risperidone (Risperdal), an antipsychotic medication for schizophrenia, has any side effects. Which response by the nurse would violate the ethical concept of veracity?
| a. | “I am not sure, but I will find out.” |
| b. | “Risperdal has no documented side effects.” |
| c. | “Risperdal does have some side effects.” |
| d. | “Let’s talk to your physician about potential side effects.” |
ANS: B
The ethical concept of veracity refers to the duty of being truthful with the client, within the scope of one’s practice. Stating that the drug has no side effects is not a truthful statement because the medication does have side effects.
PTS: 1 DIF: Cognitive Level: Application REF: p. 23
OBJ: 3 TOP: Ethical Principles
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- The charge nurse on a busy inpatient psychiatric unit is concerned because a nurse and nursing assistant have called out for the shift. Upon calling the nursing office, the charge nurse is informed that there is no one to replace them. In addition, the emergency call button at the nurse’s station is malfunctioning. This charge nurse sees this as a violation of
| a. | Legal rights |
| b. | The patient’s bill of rights |
| c. | Care provider rights |
| d. | Ethical principles |
ANS: C
Care provider rights provide for respect, safety, and competent assistance. The patient’s bill of rights deals with provision for client rights. Legal rights are not impacted, and although ethical principles serve as behavior guidelines, it is not the most appropriate response in this case.
PTS: 1 DIF: Cognitive Level: Application REF: p. 22
OBJ: 1 TOP: Care Provider Rights
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- The nurse encounters a client crying in her room. Upon talking to the client it is discovered that she is upset because a new nursing assistant made her go out for a walk with the group even though the client informed her that she waits for her daughter to go for her walk. This is a potential violation of which ethical principle?
| a. | Beneficence |
| b. | Autonomy |
| c. | Confidentiality |
| d. | Nonmaleficence |
ANS: B
Autonomy refers to the right of people to act for themselves and make personal choices. The principle of beneficence refers to actively doing good, and maleficence refers to doing no harm. Confidentiality is not violated in this situation.
PTS: 1 DIF: Cognitive Level: Application REF: p. 23
OBJ: 1 TOP: Ethics: Ethical Principles
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- A client preparing for discharge from an inpatient unit asks a nurse which psychiatrist she would recommend to use for follow-up as an outpatient. The nurse responds, “There are several good physicians on your list. Make sure you do not use Dr. Smith. I have heard some terrible things about his methods of treatment.” This is an example of which type of potential liability?
| a. | Slander |
| b. | Invasion of privacy |
| c. | Assault |
| d. | Libel |
ANS: A
Slander is verbal defamation, which is false communication, and can result in harm to the psychiatrist’s practice. Libel is written defamation, and assault is threat of bodily harm. Invasion of privacy pertains to confidential information and is not pertinent in this case.
PTS: 1 DIF: Cognitive Level: Application REF: p. 26
OBJ: 6 TOP: Areas of Potential Liability
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- A client frequently wanders around the unit, and the staff frequently needs to reorient the client to the environment and remind her not to walk into the rooms of other clients on the unit. Due to short staffing, the decision is made to use a restraint device to prevent this from occurring. This action may constitute:
| a. | Assault |
| b. | Defamation |
| c. | False imprisonment |
| d. | Negligence |
ANS: C
The application of protective devices and restraints may constitute false imprisonment. Restraints must be used only to protect the client, not for staff convenience. All less restrictive measures should first be attempted and documented.
PTS: 1 DIF: Cognitive Level: Application REF: p. 27
OBJ: 6 TOP: Areas of Potential Liability
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
MULTIPLE RESPONSE
- If a person is perceived to be a threat to himself or others, who can implement an involuntary commitment to a mental health facility? (Select all that apply.)
| a. | Family members |
| b. | Police |
| c. | Physicians |
| d. | Social workers |
| e. | Representatives of a county administrator |
ANS: B, C, E
Police, physicians, and representatives of a county administrator are the only individuals who can implement an involuntary admission to a mental health facility. An involuntary admission can last from days to years, depending on the need. A court order is necessary for extended involuntary admissions.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 26
OBJ: 5 TOP: Adult Psychiatric Admissions
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- For a nurse or health care provider to be found negligent, what requirements must the provider’s misconduct meet? (Select all that apply.)
| a. | The provider owed a duty to the client. |
| b. | The provider breached a duty to the client. |
| c. | The provider had intent to harm the client. |
| d. | The provider caused injury to the client by action or inaction. |
| e. | The provider caused loss or damage through his or her actions. |
ANS: A, B, D, E
These four criteria must be present for an act of a health care provider to be considered negligent. Intent to harm would be considered a criminal action rather than an action of negligence.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 25
OBJ: 7 TOP: Areas of Potential Liability
KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Safe and Effective Care Environment
- The use of protective devices may be considered false imprisonment. In order to assure the rights of the client are not violated, which practices must be implemented when using a device? (Select all that apply.)
| a. | A written medical order must be on the medical record |
| b. | Client must be confined to bed. |
| c. | Restraints must be removed and limb exercised every 2 hours. |
| d. | Restraints must be implemented in the event of short staffing as a preventive measure. |
| e. | Client must be assessed and monitored every 15 minutes. |
ANS: A, C, E
Restraints must be used only to protect the client, not for staff convenience. All less restrictive measures should first be attempted and documented. A written medical order for restraints must be on file in the client’s chart. Once restraints have been applied, the caregivers have an increased obligation to observe, assess, and monitor the client every 15 minutes. The restraints must be removed, one limb at a time, and the limb exercised every 2 hours. All observations and actions must be documented. Restraints are removed as soon as the client’s behavior is under control.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 27
OBJ: 7 TOP: Areas of Potential Liability
KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Safe and Effective Care Environment
COMPLETION
- The term __________ describes an individual’s attitudes, beliefs, and values and helps a person distinguish between what is considered right and wrong behavior.
ANS:
Morals
Morals are developed through learned behavior, teachings of others, and experience.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 21
OBJ: 1 TOP: Values and Morals
KEY: Nursing Process Step: Assessment
MSC: Client Needs: Safe and Effective Care Environment
- The nurse documents on the medication administration record that a medication has been given as ordered on a daily basis, but the medication actually has been out of stock for a week. This nurse is guilty of __________.
ANS:
Fraud
This nurse is committing fraud by giving false information. Not only is this illegal, but it could bring harm to the client in several ways.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 26
OBJ: 6 TOP: Areas of Potential Liability
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- __________ is either omitting or committing a duty that a reasonable and prudent person would or would not do that brings harm to an individual in a health care environment.
ANS:
Negligence
Malpractice
Negligence on the part of a professional is called malpractice.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 27
OBJ: 7 TOP: Areas of Potential Liability
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
Chapter 07: Psychotherapeutic Drug Therapy
Morrison-Valfre: Foundations of Mental Health Care, 6th Edition
MULTIPLE CHOICE
- During client teaching, the nurse must inform the client prescribed a tricyclic antidepressant (TCA) to not expect to see a difference in mood or anxiety level for up to:
| a. | 5 days |
| b. | 2 to 3 weeks |
| c. | 4 to 5 weeks |
| d. | 6 weeks |
ANS: B
It is important that the client understand that TCAs typically take 2 to 3 weeks to take effect so he will not become discouraged when he does not see immediate results.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 69
OBJ: 4 TOP: Antidepressant Medications
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
- A male client with the diagnosis of depression is taking a monoamine oxidase inhibitor (MAOI). Which is the most important teaching point the nurse must include in his care plan?
| a. | Avoid foods high in sodium content |
| b. | Avoid alcoholic beverages |
| c. | Ensure that protein intake is 60 grams per day |
| d. | Take a potassium supplement |
ANS: B
This client should be given a list of foods and beverages that are restricted when taking MAOIs, such as some alcoholic beverages, sausage and bologna, and some cheeses. Sodium, protein, and potassium are not factors when MAOIs are taken.
PTS: 1 DIF: Cognitive Level: Application REF: p. 71
OBJ: 4 TOP: Antidepressant Medications
KEY: Nursing Process Step: Planning MSC: Client Needs: Physiological Integrity
- A female client is 3-days postoperative and has been receiving meperidine (Demerol) for pain control. The family mentions to the nurse that the client has been taking phenelzine (Nardil) for years for her depression. The client did not list this medication on admission. What signs and symptoms should the nurse look for in case of reaction between these two medications?
| a. | Increased pulse and respirations |
| b. | Hyperactivity and difficulty concentrating |
| c. | Increased tearing and increased urinary output |
| d. | Sedation, disorientation, and hallucinations |
ANS: D
Nardil is a monoamine oxidase inhibitor; therefore, symptoms of CNS depression such as sedation, disorientation, and hallucinations, rather than increased vital signs, hyperactivity and difficulty concentrating, and increased tearing and urination, most likely would occur as a reaction between these two medications.
PTS: 1 DIF: Cognitive Level: Application REF: p. 70
OBJ: 4 TOP: Antidepressant Medications
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
- The nurse is aware that he or she may be administering the new antianxiety medication pregabalin (Lyrica) to clients without an anxiety disorder for the purpose of treating:
| a. | Depression |
| b. | Psychotic episodes |
| c. | Neuropathic pain |
| d. | Bipolar disorder |
ANS: C
Pregabalin (Lyrica) has been found to be effective for the treatment of neuropathic pain, as well as seizure disorders. This medication is not used for any of the other options listed.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 70
OBJ: 3 TOP: Antianxiety Medications
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
- Selective serotonin reuptake inhibitors (SSRIs) are most health care providers’ drug of choice for the treatment of depression because:
| a. | The side effects are more manageable than with other antidepressants. |
| b. | They are the only class safe for long-term therapy. |
| c. | This is the oldest class of antidepressants. |
| d. | They are fast-acting medications. |
ANS: A
The side effect most commonly reported, gastrointestinal (GI) upset, usually can be avoided if the client takes the medication with food. SSRIs can be used for both short- and long-term therapy; they are not the oldest class of antidepressants; and they usually take a few weeks before onset of effect.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 71
OBJ: 4 TOP: Antidepressant Medications
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity
- In preparing discharge planning for a client who has been prescribed lithium for the treatment of bipolar disorder, the nurse must be sure that the client demonstrates an understanding of the need to monitor his or her diet for intake of:
| a. | Potassium |
| b. | Carbohydrates |
| c. | Protein |
| d. | Sodium |
ANS: D
Lithium is a salt that is absorbed into the bloodstream and is excreted by the kidneys at a faster rate than sodium. Therefore, clients must monitor their sodium and fluid intake, as well as their activity level. The other options are not a concern when lithium is taken.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 72
OBJ: 5 TOP: Antimanic Medications
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Physiological Integrity
- A female client calls the clinic for advice after forgetting to take her morning dose of twice-daily lithium 5 hours ago. Which instructions should the nurse give the client?
| a. | Take the dose immediately, and then take the second dose 3 hours late. |
| b. | Take half of a dose now, and then take the second dose at the normal time. |
| c. | Eliminate the dose missed, and take the second dose at the normal time. |
| d. | Immediately take the missed dose, and take the second dose at the normal time. |
ANS: C
Because lithium should be taken at the same time each day and the therapeutic range is narrow, 5 hours after the first dose was missed would be too close to take the second dose to try to make it up. Altering the schedule for one missed dose could cause more problems with future doses.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 76
OBJ: 5 TOP: Antimanic Medications
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
- A female client who has had bipolar disorder for several years decides to stop all of her medications because she is tired of the side effects. She also cancels all appointments with her therapist, stating that it is just too difficult to plan the visits in her hectic schedule. This client is considered:
| a. | Depressed |
| b. | Noncompliant |
| c. | Suffering from an anxiety disorder |
| d. | Possessing obsessive-compulsive tendencies |
ANS: B
Noncompliance occurs with many individuals with mental health disorders because of the ways the side effects of the medication affect an individual as well as other factors. It is important to work with clients to prevent noncompliance. Depression, anxiety disorder, and obsessive-compulsive tendencies are not indicated in the situation described.
PTS: 1 DIF: Cognitive Level: Application REF: p. 70
OBJ: 9 TOP: Noncompliance
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity
- A male client with schizophrenia lives in an assisted-living complex for individuals with mental health disorders. He is tired of the Parkinson-like symptoms he experiences with his antipsychotic medication and therefore stops taking his medication after much discussion with his treatment team. He is progressively withdrawing from reality but is not a safety risk at this point to himself or others. What is the best response of the nurse and treatment team?
| a. | Try to coerce him into taking his medication. |
| b. | Ensure that the client and those around him are safe, and monitor for additional symptoms of his schizophrenia while maintaining trust with the client. |
| c. | Crush his antipsychotic medications and put them in his food to stop the process of his withdrawal from reality. |
| d. | Speak to his family about seeking an involuntary emergency hold in a mental health facility to get him back on his medications. |
ANS: B
The Patient Self-Determination Act states that individuals who are not in an emergency or safety-threatening situation cannot be coerced, forced, or talked into following a suggested course, such as taking medication against their will. All three remaining options go against the Act. In addition, an involuntary emergency hold in a mental facility is not reasonable because the client is not a threat to himself or others.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 77
OBJ: 9 TOP: Informed Consent
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity
- An adult female client has been diagnosed recently with mild depression but opts not to take the medication prescribed by her physician after talking with the physician about the benefits, risks, possible outcomes, and side effects. She decides to investigate alternative treatments. This client is making this decision based on the premise of:
| a. | Informed consent |
| b. | Noncompliance |
| c. | Client education |
| d. | Right to privacy |
ANS: A
Informed consent most accurately describes the situation because all aspects of taking the medication were discussed with the client before she made the decision to not take the medication. If she had already been in agreement with the regimen rather than seeking other alternatives, she would have been considered noncompliant. Client teaching, such as how and when to take the medication, would occur if she decided to take the medication. The client’s right to privacy is not addressed in this scenario.
PTS: 1 DIF: Cognitive Level: Application REF: p. 77
OBJ: 9 TOP: Informed Consent
KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Safe and Effective Care Environment
- The nurse is administering medications to a client with a diagnosis of paranoid schizophrenia. The nurse would expect to see which medication ordered for this client?
| a. | Lithium |
| b. | Depakene |
| c. | Neurontin |
| d. | Risperdal |
ANS: D
Risperdal is an antipsychotic medication that is used for schizophrenia. The other options are all antimanic medications.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 73
OBJ: 2 TOP: Antipsychotic (Neuroleptic) Medications
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
- Psychotropic medications can cause a parasympathetic and/or sympathetic response from the autonomic nervous system. Which of the following is considered a sympathetic response?
| a. | Pupil dilation |
| b. | Increased saliva production |
| c. | Decreased heart rate |
| d. | Constricted airway |
ANS: A
Pupil dilation is a sympathetic response. All the other options are examples of a parasympathetic response.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 67
OBJ: 1 TOP: How Psychotherapeutic Drug Therapy Works
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity
- While completing the history portion of an admission assessment of a client with schizophrenia, the nurse notices that the client is continually moving in the chair and frequently stands and then sits back down. The nurse knows that this client most likely is experiencing the side effect of:
| a. | Drug-induced parkinsonism |
| b. | Dystonia |
| c. | Akathisia |
| d. | Akinesia |
ANS: C
Akathisia is an extrapyramidal side effect (EPSE) of antipsychotic drugs that causes an individual to be unable to sit still. The other options are also EPSEs but are not evident in the scenario.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 73
OBJ: 6 TOP: Antipsychotic (Neuroleptic) Medications
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity
- __________ is a side effect that can occur while a client is taking an antipsychotic medication, causing muscle rigidity, high fever, unstable vital signs, confusion, and agitation.
| a. | Drug-induced parkinsonism |
| b. | Neuroleptic malignant syndrome (NMS) |
| c. | Tardive dyskinesia |
| d. | Dystonia |
ANS: B
NMS is a very serious side effect of antipsychotic drugs that can lead to coma and death. Muscle rigidity is usually the first symptom, with symptoms progressing rapidly after the onset and reaching peak intensity in 3 days. The other options are also side effects of antipsychotics but do not describe NMS.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 73
OBJ: 6 TOP: Antipsychotic (Neuroleptic) Medications
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity
- The __________ constitute a class of drugs that are commonly prescribed for cardiac arrhythmias but also have been found to be effective treatment for social phobias.
| a. | Benzodiazepines |
| b. | Tricyclics |
| c. | Azaspirones |
| d. | Beta-blockers |
ANS: D
In the past, beta-blockers were strictly cardiac drugs, but new research has found this class of drugs to be successful as adjunctive treatment for social phobias. The other options are antianxiety and antidepressant medications; they are not used for cardiac arrhythmias.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 69
OBJ: 3 TOP: Antianxiety Medications
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
- Valium is administered to a client anxious about impending surgery. Which of the following side effects is the client at risk for?
| a. | Seizures |
| b. | Falls |
| c. | Hypertensive crisis |
| d. | Tachycardia |
ANS: B
Orthostatic hypotension from use of benzodiazepines places the client at risk for falls. MAOIs may cause hypertensive crisis, seizures, and tachycardia.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 69
OBJ: 3 TOP: Antianxiety Medications
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
- When educating a client being treated with lithium, which item(s) in his or her diet should be monitored or avoided?
| a. | Fresh fruit |
| b. | Whole milk |
| c. | Hot dogs and ham |
| d. | Fresh vegetables |
ANS: C
Lithium and sodium compete for elimination from the body through the kidneys. An increase or decrease in salt affects proper elimination of lithium from the body. Processed foods like hot dogs and ham contain larger amounts of sodium.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 72
OBJ: 5 TOP: Guidelines for clients taking lithium
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
- The CMA is administering an antianxiety medication to a client. Monitoring side effects is the responsibility of which member of the health care team?
| a. | Nurse |
| b. | CMA |
| c. | Physician |
| d. | Therapist |
ANS: A
While all care providers should be aware of the actions and side effects of the client’s medication, the nurse remains responsible for monitoring drug effectiveness and adverse reactions.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 75
OBJ: 7 TOP: Drug Administration
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- Careful assessment for changes in attitude and suicidal gestures should
be monitored in a client taking which medication?
| a. | Lithium |
| b. | Ativan (lorazepam) |
| c. | Librium (chlordiazepoxide) |
| d. | Paxil (paroxetine) |
ANS: D
Clients taking Paxil (an antidepressant) should be assessed for changes in attitudes and suicidal gestures. All other medications are antianxiety agents.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 70
OBJ: 4 TOP: Antidepressant Medications
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
MULTIPLE RESPONSE
- Which of the following are basic responsibilities of nurses who administer psychotherapeutic drugs? (Select all that apply.)
| a. | Monitoring and evaluating the client’s response to the medication |
| b. | Continually assessing the client’s condition |
| c. | Adjusting medication dosages according to therapeutic levels |
| d. | Assisting in the coordination of the client’s care |
| e. | Teaching clients about their medications |
| f. | Administering prescribed medications |
ANS: A, B, D, E, F
These responsibilities require nurses to be cognizant of all aspects of medication administration. Adjusting medication dosages is not within the nurse’s scope of practice.
PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 75-76
OBJ: 7 TOP: Client Care Guidelines
KEY: Nursing Process Step: Implementation
MSC: Client Needs: Physiological Integrity
- The nurse is developing a teaching plan for a client who has been diagnosed recently with a mental health disorder and has been prescribed a psychotropic medication. Which interventions regarding the medication should the nurse include in the teaching plan? (Select all that apply.)
| a. | Teach signs and symptoms of side effects and what to do if these occur |
| b. | Provide written information regarding the purpose, dosage, route, and dosing schedule |
| c. | Ask the client and significant other to verbally explain when it is necessary to contact the physician should side effects occur |
| d. | Provide written information regarding how the client should decrease dosages in response to side effects or improvement in symptoms |
ANS: A, B, C
The nurse should teach signs and symptoms of side effects, provide information about the drug, and have the client and significant other verbally explain when it is necessary to call the physician. The nurse should never provide written information about decreasing dosages without contacting the physician. The physician will determine whether side effects can be controlled, or if dosage adjustments are necessary. In addition, improvement in symptoms is most likely the desired effect of the medication and ensures that the dosage and medications are correct.
PTS: 1 DIF: Cognitive Level: Application REF: p. 76
OBJ: 8 TOP: Client Teaching
KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention | Nursing Process Step: Evaluation MSC: Client Needs: Physiological Integrity
- Clients diagnosed with Type I-Positive Schizophreniasymptoms respond better to antipsychotic medications. Manifestations of Type I Schizophrenia include which of the following? (Select all that apply.)
| a. | Delusions |
| b. | Hallucinations |
| c. | Apathy |
| d. | Anhedonia |
| e. | Illusions |
ANS: A, B, E
Type I: Positive symptoms include delusions, illusions, and hallucinations and have a good response to medications. Type II: Negative symptoms include anhedonia, apathy, and flat affect and usually do not respond well to antipsychotic medications.
PTS: 1 DIF: Cognitive Level: Application REF: p. 73
OBJ: 6 TOP: Positive and Negative Symptoms of Schizophrenia
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
COMPLETION
- __________ side effects can occur when antipsychotic medications are taken that manifest as abnormal movements such as akathisia and pseudo-Parkinson symptoms.
ANS:
Extrapyramidal
These side effects occur as a result of an imbalance of neurotransmitters in the brain. Additional extrapyramidal side effects (EPSEs) include dyskinesia, akinesia, and dystonia.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 73
OBJ: 6 TOP: Antipsychotic (Neuroleptic) Medications
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity
- The four classes of psychotherapeutic medications include antianxiety agents, antidepressants, antimanics, and __________.
ANS:
Antipsychotics
Antipsychotics treat individuals with psychotic disorders by helping to control symptoms associated with loss of reality, such as hallucinations.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 68
OBJ: 2 TOP: Classifications of Psychotherapeutic Drugs
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity
- Lithium levels are considered toxic when they become higher than __________ mEq/L.
ANS:
1.5
Lithium therapy must be closely monitored because the therapeutic range is narrow and toxicity can be life threatening. Anything higher than 1.5 mEq/L is considered toxic.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 71
OBJ: 5 TOP: Antimanic Medications
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
Chapter 13: Problems of Childhood
Morrison-Valfre: Foundations of Mental Health Care, 6th Edition
MULTIPLE CHOICE
- Social and emotional development occurs at a more simple level in the child who is:
| a. | 5 years old |
| b. | 8 years old |
| c. | 10 years old |
| d. | 12 years old |
ANS: A
A child’s reasoning is simple and uncomplicated until the nervous system completely develops; therefore, the younger child’s social and emotional development moves from simple to complex with age.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 139
OBJ: 1 TOP: Normal Childhood Development
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
- A 10-year-old male client is 20 pounds overweight. Which intervention by the nurse is the most effective in this situation?
| a. | Place the client on a strictly controlled calorie-restricted diet |
| b. | Talk to the client about why he is so overweight |
| c. | Teach the client and his parents about healthy eating habits and choices |
| d. | Make a list of foods that are to be restricted in the client’s diet |
ANS: C
Early intervention and education are the best interventions for the treatment and prevention of childhood obesity. Teaching about healthy eating habits provides the tools necessary to correct the problem with long-term success. Placing the client on a strictly controlled calorie-restricted diet provides no education and most likely will cause a rebound effect. Talking to the client about why he is overweight may be an intervention that would occur later in the treatment process after further assessment is completed. Making a list of restricted foods also may cause a rebound effect.
PTS: 1 DIF: Cognitive Level: Application REF: p. 142
OBJ: 1 TOP: Common Behavioral Problems of Childhood
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity
- A couple comes to the sleep disorder clinic because their 3-year-old daughter has problems falling asleep every night. The parents say that it takes their daughter 1 to 2 hours each night to fall asleep, and one of the parents ends up having to lie down with her. Which intervention should the nurse first suggest?
| a. | The parents should alternate responsibility each night for seeing the daughter to bed. |
| b. | The daughter could start falling asleep in the parents’ bed and then could move to her own bed |
| c. | Place the child in bed at the same time each night, and don’t allow her to get out of bed |
| d. | Follow a bedtime ritual each night, such as reading one book |
ANS: D
One of the first steps in dealing with problems with sleep is following a bedtime ritual each night so as to establish a restful sleep pattern. Additional interventions include limiting watching television. The other options do not establish a restful bedtime ritual that will encourage sleep.
PTS: 1 DIF: Cognitive Level: Application REF: p. 140
OBJ: 1 TOP: Common Behavioral Problems of Childhood
KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity
- The parents of a 2-year-old boy seek assistance at a family therapy clinic because their son throws a temper tantrum every time he is not allowed to throw his food on the floor during meals. Which therapeutic intervention does the nurse suggest?
| a. | Leave him during the tantrum, so that he feels isolated from others as a result of his behavior |
| b. | Try to distract him when he becomes frustrated, and reward him for positive behavior |
| c. | Hold the child down until the tantrum stops |
| d. | Put him in the corner for punishment while he is having the tantrum |
ANS: B
Distracting the child may lessen his frustration and prevent the tantrum from occurring, and rewarding positive behavior encourages future positive behavior. Leaving him may frighten him and/or he could hurt himself during the tantrum. Holding the child down will increase his frustration, and putting him in the corner is not effective during a tantrum because his behavior is out of control, so he won’t understand the importance of the punishment.
PTS: 1 DIF: Cognitive Level: Application REF: p. 140
OBJ: 1 TOP: Common Behavioral Problems of Childhood
KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity
- Poverty influences the growth and development of children and is often a precursor to mental health disorders in children. Nearly __________ of children in the United States come from families that live at the poverty level.
ANS: B
Children who live in poverty score lower on IQ tests and exhibit higher rates of anxiety, unhappiness, and fearfulness than do children who are not living in poverty.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 141
OBJ: 2 TOP: Environmental Problems
KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance
- During the interview process with a homeless client, which is an appropriate nursing action?
| a. | Wait until later in the interview to ask questions such as address or nearest relative |
| b. | Ask the client early in the interview what is his or her highest education level |
| c. | Ask the client where he or she planned to sleep that night |
| d. | Encourage the client to bathe as soon as possible |
ANS: A
Asking these questions later in the interview will allow for some development of rapport and trust, so the client will more freely discuss these topics. In addition, the client may be ashamed to admit to not having an address. Asking the client about his or her highest level of education early in the conversation would make the client feel inadequate and would prevent the establishment of good rapport with the client. Asking the client about a sleeping location would occur during discharge planning, and encouraging immediate bathing would belittle the client.
PTS: 1 DIF: Cognitive Level: Application REF: p. 142
OBJ: 2 TOP: Homelessness
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity
- Adult disorders such as chronic anxiety and depression often are associated with childhood:
| a. | Illnesses |
| b. | Fears |
| c. | Education |
| d. | Abuse |
ANS: D
Abuse experienced as a child often is assessed in adults with physical, behavioral, and emotional disorders. Illnesses, fears, and education are not typical causes of adult depression and chronic anxiety.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 143
OBJ: 2 TOP: Abuse and Neglect
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity
- For children older than 4 years, separation anxiety should last for no longer than:
| a. | A few days |
| b. | A few weeks |
| c. | A few months |
| d. | 1 year |
ANS: B
If separation anxiety (a child’s fear of being apart from his parents) lasts longer than a few weeks, it is likely that there is a problem, and treatment should be sought. High levels of anxiety in children sometimes result in obsessive-compulsive behaviors.
PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 143-144
OBJ: 3 TOP: Anxiety KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- The parents of a 9-year-old girl with mental retardation voice concerns to the nurse regarding their child’s eating insects and leaves. The parents report that this behavior has been occurring for almost 4 months. From what is this child most likely suffering?
| a. | Pica |
| b. | Rumination disorder |
| c. | Enuresis |
| d. | Encopresis |
ANS: A
Pica is an eating disorder that is most commonly seen in children with mental retardation, pervasive developmental disorders, such as autism, or severe vitamin or mineral deficiencies. Treatment is aimed at keeping the child away from the items consumed and/or replacing the consumed item with a healthy food product. Rumination disorder describes a disorder in infants in which regurgitation and rechewing of the food occur. Enuresis is bedwetting, and encopresis is repeated defecation in inappropriate places.
PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 147-148
OBJ: 1 TOP: Eating Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
- As the caregiver for a male client whose mental retardation level is classified at a moderate level, the nurse’s most appropriate action is to:
| a. | Encourage him to work in a supervised setting at a fast food restaurant |
| b. | Persuade him to look for an apartment in which he can live on his own |
| c. | Find a group home that he would adjust well to |
| d. | Seek placement for him in a long-term setting for clients with cognitive disabilities |
ANS: A
A client at a moderate level of mental retardation has good communication skills, functions academically at a second grade level, benefits from vocational training by becoming employed in supervised settings, and is successful in living in the community with supervision. Living in an apartment alone applies to a client with mild retardation; living in a group home applies to a client with severe retardation; and placement in a long-term setting for clients with cognitive disabilities applies to a client with profound retardation.
PTS: 1 DIF: Cognitive Level: Application REF: p. 148
OBJ: 6 TOP: Mental Retardation
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity
- A 12-year-old female client with a normal IQ has difficulty with math at school. She performs well in all subjects except math, for which she is unable to earn above a grade of “D,” no matter how much she studies. What is this client most likely suffering from?
| a. | Mental retardation |
| b. | A learning disorder |
| c. | Pervasive developmental disorder |
| d. | An anxiety disorder |
ANS: B
Because this client performs well in all other areas and has a normal IQ, she most likely has a learning disorder. Learning disorders typically affect a child’s thinking, reading, writing, calculating, spelling, or listening abilities. The client does not have mental retardation because her IQ is normal; pervasive developmental disorder indicates difficulties with social interactions and communication skills; and an anxiety disorder refers to a vague feeling of uneasiness that persists.
PTS: 1 DIF: Cognitive Level: Application REF: p. 149
OBJ: 7 TOP: Learning Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
- The parents of a 3-year-old boy are concerned because their son seems to speak very slowly and has an odd rhythm to his speech pattern. What is this child most likely experiencing?
| a. | Reading disorder |
| b. | Phonological disorder |
| c. | Stuttering disorder |
| d. | Expressive language disorder |
ANS: D
An expressive language disorder is a disorder of communication that is of concern if the problem persists or interferes with the child’s daily activities or ability to learn and function at the expected academic level. A reading disorder most likely would be difficult to determine at this age; a phonological disorder refers to an inability to use sounds and speech as expected at a given age; and a stuttering disorder refers to frequent repetition of sounds or portions of words.
PTS: 1 DIF: Cognitive Level: Application REF: p. 149
OBJ: 1 TOP: Communication Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
- A 7-year-old male client displays behaviors such as an inability to make eye contact with others, inappropriate facial expressions, difficulty in making friends, and showing little emotion with family members. He talks with adults but is awkward in his conversation. Given these behaviors, what is this client most likely experiencing?
| a. | Childhood disintegrative disorder |
| b. | Asperger’s syndrome |
| c. | Dyslexia |
| d. | Rett syndrome |
ANS: B
These classic behaviors are associated specifically with Asperger’s syndrome. Childhood disintegrative disorder describes a condition in which the child regresses in various areas after 2 years of normal development. Dyslexia is a learning disorder in which individuals have difficulty integrating visual information. Rett syndrome refers to problems with motor, language, and social development between the ages of 5 months and 4 years.
PTS: 1 DIF: Cognitive Level: Application REF: p. 150
OBJ: 8 TOP: Pervasive Developmental Disorders
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity
- The Denver II is a tool that is used for assessment of early childhood development. What is this tool used to assess?
| a. | Temperament |
| b. | Maturation |
| c. | Gross and fine motor skills |
| d. | Speech development |
ANS: C
In addition to motor skill assessment, the Denver II assesses language and social skills. Temperament is assessed with several tools, such as the Toddler Developmental Scale and the Middle Childhood Questionnaire; maturation is assessed with the Preschool Readiness Screening Scale tool; and speech development is assessed with the Early Language Milestone Scale.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 152
OBJ: 9 TOP: Therapeutic Actions—Provide Opportunities
KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance
- The emotional developmental task of industry vs. inferiority that occurs in childhood is characteristic of which age group?
| a. | Infancy: birth to 1 year old |
| b. | Early childhood: 1 to 3 years old |
| c. | Preschool age: 3 to 6 years old |
| d. | School age: 6 to 12 years old |
ANS: D
Industry vs. inferiority is the developmental task of school-age children. The developmental task of infancy is trust vs. mistrust; of early childhood is autonomy vs. shame and doubt; and of preschool-age children is initiative vs. guilt.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 140
OBJ: 1 TOP: Normal Childhood Development
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance
- Breath-holding spells typically occur when a child becomes extremely frustrated, cries, and either intentionally or unintentionally holds his or her breath. This rarely occurs in children younger than the age of __________.
| a. | 6 months |
| b. | 12 months |
| c. | 18 months |
| d. | 24 months |
ANS: A
Breath holding usually does not occur prior to this age, but it can occur until approximately 5 years of age. Breath holding resolves itself in 30 to 60 seconds. After the first incident, the child should be examined by a physician, but if no problems are identified, the best intervention for future incidents is ignoring the behavior.
PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 140-141
OBJ: 1 TOP: Common Behavioral Problems of Childhood
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance
- A mother of a 9-year-old is concerned because her child complains of frequent stomach aches in the morning before leaving for school. No medical reason has been found for this condition. The family has recently moved to the area after the woman and her husband divorced, and the child is attending a new school. What is the most appropriate response the nurse can give to this mother?
| a. | Ignore the child’s complaints and send the child to school |
| b. | Allow the child to stay home from school when this occurs |
| c. | Provide support and reassurance to the child as the child adjusts |
| d. | Take away computer privileges to stop this behavior |
ANS: C
A somatoform disorder is one in which the child (or adult) has the signs or symptoms of illness without a traceable physical cause. Somatic symptoms are common in school-age children. They are thought to be expressions of stress, anxiety, or underlying conflict. It is important to remember that children with somatoform disorders need understanding and reassurance rather than punishment or concessions. The child should not be ignored.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 144
OBJ: 3 TOP: Common Behavioral Problems of Childhood
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity
- The school nurse meets with the parents of a 7-year-old child who frequently shows a lack of respect for his teacher and the rules of the classroom. His parents report that he fights with his siblings and has tried to run away from home when they have attempted to take away privileges. Based on this assessment, what does the nurse understand about his future?
| a. | He is experiencing a normal developmental task and will grow out of it. |
| b. | His prognosis for recovery will be good if he is not punished. |
| c. | Due to his age, his future prognosis is poor. |
| d. | He should be allowed to set his own limits. |
ANS: C
The long-term outlook for children with conduct disorders is poor if the problems are present before the child is 10 years old. This behavior is not typical, and relaxing rules and discipline will not aid in his recovery.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 147
OBJ: 5 TOP: Disruptive Behavioral Disorder
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity
- Due to the proximal to distal physical development of the child, which of the following motor skills is able to be accomplished by the toddler?
| a. | Tying shoes |
| b. | Buttoning a shirt |
| c. | Eating finger foods |
| d. | Cutting food with a fork and knife |
ANS: C
Eating finger foods is a gross motor skill. Tying shoes, buttoning shirts, and cutting with a knife require fine motor development.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 140
OBJ: 1 TOP: Normal Childhood Development
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance
- The parents of a 5-year-old are concerned because he has recently starting wetting himself during the day while at school. They inform their pediatrician about this when they bring their newborn daughter in for her first immunizations. After ruling out any physical cause, the pediatrician informs the parents that this is due to:
| a. | Primary nocturnal enuresis |
| b. | Secondary enuresis |
| c. | Encopresis |
| d. | Disobedience |
ANS: B
Secondary enuresis develops when a bladder-trained child becomes incontinent. Usually it follows a stressful event, such as the birth of a sibling or a divorce.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 148
OBJ: 4 TOP: Normal Childhood Development
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
- The parents of a 9-year-old boy have been told by the child’s teacher that he exhibits symptoms of attention-deficit/hyperactivity disorder (ADHD). Which specific behaviors may the child exhibit for this diagnosis to be made? (Select all that apply.)
| a. | Frequently interrupts or intrudes on others |
| b. | Is easily distracted by outside stimuli |
| c. | Has feelings of restlessness or frequently fidgets with hands and/or feet |
| d. | Exhibits an excellent short-term memory |
| e. | Often leaves tasks incomplete |
ANS: A, B, C, E
These are a few of the behaviors displayed in children with ADHD. Symptoms of ADHD include 14 possible behaviors. For a diagnosis to be made, the client must exhibit at least eight of these behaviors for at least 6 months. An excellent short-term memory is the opposite of what is seen in clients with ADHD.
PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 145-146
OBJ: 4 TOP: Attention-Deficit/Hyperactivity Disorder
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
- Before the diagnosis of mental retardation can be made, which factors must be present? (Select all that apply.)
| a. | IQ of 70 to 100 |
| b. | Inability to communicate effectively |
| c. | Poor adaptation to social situations |
| d. | IQ less than 70 |
| e. | Inability to care for self appropriate to age |
| f. | Maladaptive coping skills |
ANS: B, C, D, E, F
The criteria for the diagnosis of mental retardation include an IQ below 70 and the child’s adaptive functioning level. How well the child copes with everyday life situations is the most accurate indicator of mental retardation.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 148
OBJ: 6 TOP: Mental Retardation
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
- A fifth grade teacher is concerned that one of his students is at risk for violent behavior. Which signs will the school nurse advise him to be aware of ? (Select all that apply.)
| a. | Enjoys contact sports |
| b. | Engages in risk-taking behaviors |
| c. | Has frequent angry outbursts |
| d. | Threatens classmates |
| e. | Isolates self from others |
| f. | Damages school property |
ANS: B, C, D, F
Risk-taking behaviors, frequent loss of temper, announcing threats, and vandalizing or damaging property are all warning signs of violence. Engaging in contact sports is a normal activity for school-age children. Isolation from others is more indicative of depression.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 145
OBJ: 5 TOP: Warning Signs of Violence
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
COMPLETION
- __________ is a disorder that involves an individual’s ability to communicate, interact with others, use the imagination, and display appropriate behavior.
ANS:
Autism
Autism is a disorder, rather than a disease, that results from a problem in the development of the nervous system. There are different types and degrees of autism, and the disorder can affect the child for the rest of his or her life.
PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 149-150
OBJ: 8 TOP: Pervasive Developmental Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
- The developmental period of middle childhood is considered to encompass the ages of __________ to __________ years.
ANS:
6, 10
Each developmental period has specific developmental expectations that must be met for growth and development to continue.
PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 139
OBJ: 1 TOP: Normal Childhood Development
KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance
