Chapter 13: Problems of Childhood

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Chapter 12: The Therapeutic Environment

Multiple Choice

1. 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.

DIF: Cognitive Level: Comprehension REF: p. 140 OBJ: 1

TOP: Normal Childhood Development KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity 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.

2. 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?

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.

DIF: Cognitive Level: Application REF: p. 141 OBJ: 1

TOP: Common Behavioral Problems of Childhood

KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 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.

3. 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?

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.

DIF: Cognitive Level: Application REF: p. 142 | Box 13.2

OBJ: 1 TOP: Common Behavioral Problems of Childhood

KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity a. 10% b. 20% c. 30% d. 40%

4. 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.

DIF: Cognitive Level: Knowledge REF: p. 143

OBJ: 2

TOP: Environmental Problems KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance 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.

5. During the interview process with a homeless client, which is an appropriate nursing action?

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.

DIF: Cognitive Level: Application REF: p. 144 | Box 13.4

OBJ: 2 TOP: Homelessness

KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

6. 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.

DIF: Cognitive Level: Knowledge REF: p. 144 OBJ: 2

TOP: Abuse and Neglect KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity

7. 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.

DIF: Cognitive Level: Knowledge REF: p. 145 OBJ: 3

TOP: Anxiety KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Pica b. Rumination disorder c. Enuresis d. Encopresis

8. The parents of a 9-year-old girl with intellectual disability 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?

ANS: A

Pica is an eating disorder that is most commonly seen in children with intellectual disability, 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 bed-wetting, and encopresis is repeated defecation in inappropriate places.

DIF: Cognitive Level: Comprehension REF: p. 149 OBJ: 1

TOP: Eating Disorders KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

9. As the caregiver for a male client whose intellectual disability 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 intellectual disability 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 intellectual disability; living in a group home applies to a client with severe intellectual disability; and placement in a long-term setting for clients with cognitive disabilities applies to a client with profound intellectual disability.

DIF: Cognitive Level: Application REF: p. 150 | Table 13.6

OBJ: 6 TOP: Intellectual Disability

KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity a. Intellectual disability b. A learning disorder c. Pervasive developmental disorder d. An anxiety disorder

10. 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?

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 intellectual disability 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.

DIF: Cognitive Level: Application

TOP: Learning Disorders

MSC: Client Needs: Psychosocial Integrity

REF: p. 150 OBJ: 7

KEY: Nursing Process Step: Assessment a. Reading disorder b. Phonological disorder c. Stuttering disorder d. Expressive language disorder

11. 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?

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.

DIF: Cognitive Level: Application REF: p. 150 OBJ: 1

TOP: Communication Disorders KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Childhood disintegrative disorder b. Asperger’s syndrome c. Dyslexia d. Rett syndrome

12. 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?

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.

DIF: Cognitive Level: Application REF: p. 151 OBJ: 8

TOP: Pervasive Developmental Disorders

KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity a. Temperament b. Maturation c. Gross and fine motor skills d. Speech development

13. The Denver II is a tool that is used for assessment of early childhood development. What is this tool used to assess?

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.

DIF: Cognitive Level: Knowledge REF: p. 153 | Table 13.8

OBJ: 9 TOP: Therapeutic Actions Provide Opportunities

KEY: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance 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

14. The emotional developmental task of industry vs. inferiority that occurs in childhood is characteristic of which age-group?

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.

DIF: Cognitive Level: Knowledge REF: p. 141 | Table 13.2

OBJ: 1 TOP: Normal Childhood Development

KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Health Promotion and Maintenance a. 6 months b. 12 months c. 18 months d. 24 months

15. 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 .

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.

DIF: Cognitive Level: Knowledge REF: p. 141 OBJ: 1

TOP: Common Behavioral Problems of Childhood

KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Health Promotion and Maintenance 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.

16. 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?

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.

DIF: Cognitive Level: Knowledge REF: p. 145

TOP: Common Behavioral Problems of Childhood

OBJ: 3

KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 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.

17. 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?

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.

DIF: Cognitive Level: Knowledge REF: p. 148

OBJ: 5

TOP: Disruptive Behavioral Disorder KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity a. Tying shoes b. Buttoning a shirt c. Eating finger foods d. Cutting food with a fork and knife

18. 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?

ANS: C

Eating finger foods is a gross motor skill. Tying shoes, buttoning shirts, and cutting with a knife require fine motor development.

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

19. 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.

DIF: Cognitive Level: Knowledge REF: p. 149 OBJ: 4

TOP: Normal Childhood Development KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. 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.

DIF: Cognitive Level: Comprehension REF: p. 147 OBJ: 4

TOP: Attention-Deficit/Hyperactivity Disorder

KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 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

2. Before the diagnosis of intellectual disability can be made, which factors must be present? (Select all that apply.)

ANS: B, C, D, E, F

The criteria for the diagnosis of intellectual disability 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 intellectual disability.

DIF: Cognitive Level: Comprehension REF: p. 149 OBJ: 6

TOP: Intellectual Disability KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity 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.

3. 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.)

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.

DIF: Cognitive Level: Comprehension REF: p. 146 OBJ: 5

TOP: Warning Signs of Violence KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity