Nokea
A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child has formed a trusting relationship with a volunteer. The teen says, 'I have three good friends at school. We talk and sit together at lunch.' What is the nurse's best suggestion to the treatment team?
- A. Suggest foster home placement.
- B. Seek assistance from an intimate partner violence program.
- C. Make referrals for existing and emerging developmental problems.
- D. Encourage healthy characteristics and existing environmental supports.
Correct Answer: D
Rationale: Because the teenager shows no evidence of poor mental health, the best action would be to foster existing healthy characteristics and environmental supports. No other option is necessary or appropriate under the current circumstances.
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An adolescent diagnosed with generalized anxiety disorder says, 'My parents focus all their attention on my brother instead of me. He's perfect in their eyes.' Which type of therapy might promote the greatest change in this adolescent's behavior?
- A. Bibliotherapy
- B. Play therapy
- C. Family therapy
- D. Behavior modification therapy
Correct Answer: C
Rationale: Family therapy focuses on problematic family relationships and interactions. The patient has identified problems within the family. Bibliotherapy and play therapy are appropriate for children rather than adolescents. The adolescent's problem is interpersonal and relates to relationships and self-perception; therefore, behavior modification therapy would not help.
When a 5-year-old child is disruptive, the nurse says, 'You must take a time-out.' The expectation is that the child will demonstrate what behavior?
- A. Go to a quiet room until called for the next meal.
- B. Slowly count to 20 before returning to the group activity.
- C. Sit on the edge of the activity until able to regain self-control.
- D. Sit quietly on the lap of a staff member until able to apologize for the behavior.
Correct Answer: C
Rationale: Time-out is designed so that staff can be consistent in their interventions. Time-out may require having the child sit on the periphery of an activity until he or she gains self-control and reviews the episode with a staff member. Time-out may not require having the child go to a designated room and does not involve special attention such as holding. Having the child count to 10 or 20 is not sufficient.
A 15-year-old adolescent is referred to a residential program after an arrest for theft and running away from home. At the program, the adolescent refuses to participate in scheduled activities and pushes a staff member, causing a fall. Which approach by the nursing staff would be most therapeutic?
- A. Neutrally permit refusals.
- B. Coax to gain compliance.
- C. Offer rewards in advance.
- D. Establish firm limits.
Correct Answer: D
Rationale: Firm limits are necessary to ensure physical safety and emotional security. Limit setting will also protect other patients from the teenager's thoughtless or aggressive behavior. Permitting refusals to participate in the treatment plan, coaxing, and bargaining are strategies that do not help the patient learn to abide by rules or structure.
Which behavior indicates that the treatment plan for a child diagnosed with autism spectrum disorder was effective?
- A. Plays with one toy for 90 minutes.
- B. Repeats words spoken by a parent.
- C. Holds the parent's hand while walking.
- D. Spins around and claps hands while walking.
Correct Answer: C
Rationale: Holding the hand of another person suggests relatedness. Usually, a child with autism would resist holding someone's hand and stand or walk alone, perhaps flapping arms or moving in a stereotypical pattern. The other options reflect behaviors that are consistent with autistic disorder.
A 15-year-old adolescent has run away from home six times. After the adolescent was arrested for prostitution, the parents told the court, 'We can't manage our teenager.' The adolescent is physically abusive to the mother and defiant with the father. The adolescent's problem is most consistent with criteria for which disorder?
- A. Attention-deficit/hyperactivity disorder (ADHD)
- B. Childhood depression
- C. Conduct disorder (CD)
- D. Autism spectrum disorder (ASD)
Correct Answer: C
Rationale: CDs are manifested by a persistent pattern of behavior in which the rights of others and age-appropriate societal norms are violated. The Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5) identifies CDs as serious violations of rules. The patient's clinical manifestations do not coincide with the other disorders listed.