Ch. 20 - Psychotherapy With Children - TB

There are many roles involved in caring for clients in the specialized area of child psychiatry. Which of the following diverse clinical functions includes the role of the nurse generalist working in child psychiatry?
Select all that apply.

1. Administer medication
2. Utilize knowledge and skills related to the mental health needs of clients
3. Prescribe psychotropic medications
4. Utilize knowledge related to the physical health needs of clients
5. Order diagnostic tests necessary to monitor effects of psychotropic medications
Click the card to flip 👆
1 / 29
Terms in this set (29)
There are many roles involved in caring for clients in the specialized area of child psychiatry. Which of the following diverse clinical functions includes the role of the nurse generalist working in child psychiatry?
Select all that apply.

1. Administer medication
2. Utilize knowledge and skills related to the mental health needs of clients
3. Prescribe psychotropic medications
4. Utilize knowledge related to the physical health needs of clients
5. Order diagnostic tests necessary to monitor effects of psychotropic medications
Correct Answer: 1, 2, 4

Rationale 1: Administer medication. The nurse generalist working in child psychiatry will
administer medications that require strict and systematic monitoring

Rationale 2: Utilize knowledge and skills related to the mental health needs of clients. The nurse generalist working in child psychiatry will assess psychological symptoms.

Rationale 4: Utilize knowledge related to the physical health needs of clients. The nurse
generalist working in child psychiatry will assess physical symptoms.
A nurse generalist and advanced practice nurse both work on the staff of an inpatient unit. The advanced practice nurse has a comprehensive role as a primary caregiver in child psychiatry. Which of the following will be performed by the advanced practice nurse but not by the nurse
generalist?

1. Explaining the treatment plan to a family
2. Performing admission assessments
3. Participating in discharge planning
4. Providing one-to-one counseling
4.

Child psychiatric-mental health nurses are involved in treatment, consultation, education, and medication supervision and are the mainstay of hospital treatment programs where they are responsible for daily treatment plans, ongoing one-to-one or group counseling, and management of the childs medication regimen. You will see advanced practice nurses as the primary caregivers for children with mental health problems, providing direct psychotherapy,
working with the family, and managing the childs medications.
A growing role of the child psychiatric mental health nurse is:

1. Scrutinizing the public.
2. Promoting infant mental health.
3. Monitoring adult inpatient psychiatric clients.
4. Preventing mental health problems.
2.

A growing role for child psychiatric mental health nurses involves promotion of infant mental health in high-risk families in which the infants have medical complications or the parents have a history of mental illness or substance abuse. Monitoring adults and scrutinizing the public are not part of the child psychiatric-mental health nurses role. Nurses can advocate for mental health issues, but they cannot prevent mental health problems.
When discussing indicators of emotionally disturbed children or children with disruptive behavior disorders with a group of student nurses, the psychiatric nurse states that one of the best indicators of emotionally disturbed children is that they have difficulty:

1. Seeking out peers.
2. Digesting a balanced diet.
3. Interpreting internal stimuli or external cues.
4. Following rules and norms of behavior.
4.

The central feature of a conduct disorder is repetitive and persistent behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. Look for behaviors that show aggression toward people and animals, destruction of property, deceitfulness or theft, or serious violations of parental or school rules. The ability to digest a balanced diet is not an indicator of an emotionally disturbed child. Children with a conduct
disorder tend to find peers with similar issues. Interpreting internal stimuli or external cues is not related to conduct disorders.
The nurse observes an 8-year-old child regressing to behavior that is characteristic of a toddler when faced with new situations. The child has been in several foster care families over the past three years. Which of the following interventions is appropriate for this child?

1. Providing for unmet needs
2. Providing consistency and continuity of caregivers
3. Ignoring the regressive behavior
4. Ignoring the negative behavior and reinforcing the positive behavior
2.

Defense mechanisms commonly employed by children are repression, reaction formation, and projection. The child comes to deal with the world through these distorted views in an attempt to defend against painful unconscious issues. Providing the child with consistency and continuity of caregivers will minimize situations that stimulate regression. The nurse will be able to evaluate the clients response to having consistency and continuity of caregivers. The nurse must recognize this behavior as a defense mechanism, and plan care that will strengthen
the childs coping mechanisms. Providing for unmet needs is not specific or individualized and will be difficult to measure.
The parents of a premature infant are visiting their baby in the neonatal intensive care unit for the first time. The nurse observes the couple standing beside the incubator. Which of the following interventions will help facilitate the infants immediate mental health needs?

1. Notify the infants physician to come and talk with the parents
2. Facilitate stroking and touching their infant
3. Continue to observe their interactions to rule out a problem with bonding
4. Have them meet with other parents of premature infants
2.

Helping the parents stroke and touch their infant is the first step in facilitating the
attachment process, which is essential to developing a socioemotional bond. Having the parents meet with the physician or other parents of premature infants will be beneficial but will not help meet the infants immediate mental health needs. The nurse will need to observe the new familys interactions, but intervening to help the parents interact with their infant would be the priority action.
The nurse is meeting for the first time with a child who was brought to the clinic with a mental health concern. When planning care for a child with a mental health problem, the nurse must understand both the childs mental health problems and the childs:

1. Previous hospitalizations.
2. Life experiences.
3. Physiological health problems.
4. Artistic ability.
2.

The nurse must understand the pathology involved in the childs mental health problems and the childs life experiences, as they may contribute to the childs problems as well as
strengths. Physiological health problems, artistic abilities, and previous hospitalizations are components of the childs life experiences. These must be considered in order to develop interventions that are appropriate to the child.
The nurse providing case management to a child with a mental illness will collect data from the childs parents, teachers, and other health care providers in order to:

1. Complete a mental status exam.
2. Complete a comprehensive evaluation.
3. Collaborate with individuals that are significant to the child.
4. Complete a personality profile.
2.

A comprehensive evaluation includes collecting data from the various individuals,
including the childs parents, teachers, and other health care providers. The comprehensive assessment is important in order to gain understanding into the variables that impact the childs mental health. Data for the mental status exam and personality profile is not gathered from parents, teachers, and other health care providers. The purpose for gathering the data is to complete the comprehensive assessment; collaboration may be a result of the process.
A nurse is describing the multicausal perspective of mental health and illness to the parents of a child recently diagnosed with a spectrum disorder. Which statement would the nurse utilize when describing this approach?

1. Exposure to drugs and alcohol has been associated with psychiatric disorders.
2. The feedback mechanism appears dysfunctional, creating neurotoxic effects on brain
development and function.
3. The childs genetically determined attributes and life experiences interact to influence mental health outcomes.
4. Early psychological trauma may create deficits or abnormalities in brain structure.
3.

The childs genetically determined attributes and life experiences interacting to influence mental health outcomes explains the perspective of the multicausal model of mental health and illness. Discussing feedback mechanism dysfunction would provide a partial explanation of neuroendocrine reactivity. Discussing the effects of early psychological trauma on
brain structure partially explains nervous system responsiveness. Discussing the association of exposure to drugs and alcohol to psychiatric disorders partially explains complications occurring during the perinatal period as a cause of some mental illnesses.
A mother told the nurse she was appalled that the nurse would dare to ask if she took any drugs during her pregnancy. The nurse explains that the information is important in understanding the childs health because embryonic exposure to toxins during pregnancy is the major risk factor for:

1. Depression in preschoolers.
2. Lactose intolerance.
3. Mental retardation.
4. Mental illness.
3.

The major risk factor for retardation is the early alteration of embryonic development because of exposure to toxins in utero (maternal drug use, for example) or
chromosomal changes (such as Down syndrome). Depression in preschoolers, mental illness, and lactose intolerance are not associated with maternal drug use.
A mother is concerned because her 6-year-old son stutters. She wants to know if she did anything during her pregnancy to cause this. Which of the following would be the best response? The nurse should: 1. Assess for impaired thermoregulation during the postnatal period. 2. Assess for a family history of the disorder. 3. Verbalize the implied by asking, Are you saying you feel responsible for his problem? 4. Ask if the mother had preeclampsia during labor.2. The only known predisposing factor for the development of a communication disorder is a family history of the disorder. For stuttering, especially, family and twin studies provide strong evidence of a genetic factor in its etiology. Since family history is the only known predisposing factor, asking about impaired thermoregulation or preeclampsia is not relevant. Questioning the mothers feelings does not address the cause of the stuttering.A 7-year-old child recently experienced the death of the familys pet dog, which was the child constant companion. The child is at risk for: 1. A conduct disorder. 2. Elimination disorder. 3. Angoraphobia. 4. Separation anxiety disorder.4. Separation anxiety disorder involves a developmentally inappropriate and excessive anxiety over separation from home or from attachment figures and may appear after a stressful life event such as the death of a pet. This childs dog may be viewed as an attachment figure, thus placing this child at risk for a separation anxiety disorder. Risk factors for conduct disorder are related to difficulties with parent-child interactions. Children with elimination problems may have psychosocial risk factors; however, the best response in this situation is to develop interactions to prevent separation anxiety disorder, which can be directly linked to the death of the child companion. Angoraphobia is the fear of soft sweaters and rabbits and is not related to this situationA mother questions why it is important to list when her child sat up, began crawling, started walking, and was potty trained as she is bringing the toddler in because the child screams at night. The nurse explains to the mother that: 1. It is not normal for a young child to scream at night. 2. Children who scream at night have more difficulty with problem solving. 3. Children with mental disorders have difficulty with elimination at night. 4. A developmental history is part of assessing well-being of a child4. The basics of an effective assessment include gathering cultural and developmental information, eliciting a history from the parents, and undertaking a clinical assessment of the child. These are developmental milestones. It is important to obtain information about the child to assist in identifying developmental progress. Night terrors are common in younger children and tend to happen when the child is in a deep sleep. The statements that children with mental disorders have difficulty with elimination at night and children who scream at night have more difficulty with problem-solving are incorrect.Which of the following behaviors observed by the nurse will be important to disclose to the teacher of a child with a stereotypic movement disorder? 1. An episode of self-mutilation 2. Depression that results from feelings of inadequacy 3. Tendency to be hypoactive 4. Flexibility and ability to contribute to learning1. Some children with a spectrum disorder have many associated behavioral problems such as hyperactivity, aggressiveness, self-injurious behaviors such as head banging, and temper tantrums. This is important and relevant to discuss with the childs teacher who is a member of the treatment team. Problems with socialization and communication difficulties are also common, evidenced by deficits in spontaneous, imaginative play. Stereotypic movement disorder involves repetitive nonfunctional motor behavior (i.e., hand waving, self-biting, body rocking, or head banging) that interferes with normal activity or risks self-inflicted bodily injury. The behavior lasts 4 weeks or longer. These behaviors are seemingly driven and protective measures are usually needed so that medical treatment will not be necessary. These children will have difficulty adapting to change, so they will have great difficulty, if able at all, to be flexible or contribute to their learning. The childs tendency would be toward hyperactivity rather than hypoactivity.The school nurse is observing a young child who has episodes of rage toward peers during recess and at lunchtime. The advantage of conducting an assessment in this environment is: 1. This will assist in identifying the bullies who trigger the explosive episodes. 2. This provides an opportunity to collect data in the event that other children are injured and legal documentation is needed. 3. To provide data for the parents who are in denial about the problem. 4. This provides a picture of problems and strengths in a realistic context.4. Play has been described as the work of children. Observing the child interacting with peers during recess and lunchtime enables the nurse to observe the child during unstructured play, which is part of the mental status assessment. The nurse is not observing the child due to a potential lawsuit, to help identify bullies, or to provide data for the parents who are in denial, but as part of a nursing assessment.The nurse is assessing a depressed child who was referred by the elementary school nurse. What is the best approach to use when assessing the childs socialization? 1. Tell me about the friends you enjoy being with. 2. So you spend a lot of time with your friends? 3. You seem like a person who would have a lot of friends. 4. How many friends do you have at school?1. The nurse is using therapeutic communication and encouraging the client to talk about a positive aspect of life. You seem like a person who would have a lot of friends, is a judgmental observation that may also be viewed as a stereotypical comment. The question How many friends do you have at school? can be perceived as probing and intrusive, which is nontherapeutic. So you spend a lot of time with your friends? invites a yes or no response and does not facilitate exploring the childs feelings about the friends.The nurse is assessing a child diagnosed with conduct disorder. Which would be the most appropriate question to ask the parents? 1. Does your child have a history of cruelty to other people and animals? 2. Does your child unconsciously direct feelings and desires from other relationships toward others? 3. Does your child seem to be reassured by your presence? 4. Does your child readily seek out caregivers in times of stress?1. Characteristics of conduct disorder often manifest in behaviors that show aggression toward people and animals; these symptoms may appear as early as 5 or 6 years of age, but occur more typically in later childhood or early adolescence. Transference is a process whereby the child unconsciously directs feelings and desires from other relationships in life onto the therapist. A child who feels secure will readily seek out caregivers in times of stress and is reassured by the caregivers presence.When planning a new childrens mental health clinic, the nurse understands the importance of including a play area. Play and toys are used to assess children with suspected mental disorders because: 1. Children do not usually relate to adults. 2. Children express themselves through play. 3. Only toys that are developmentally appropriate and specific to the childs biological age are used. 4. Play enables the nurse to assess cognitive ability.2. A mental status exam on a child consists of both a semi-structured interview and an unstructured play session with the child. Observing a child at play can also provide invaluable information about motor behavior, thought content, affect, and impulse control. There is a general belief that toys with ambiguous meaning and diverse uses foster symbolic play more effectively because they allow the child to project his or her own identity and function onto the toys. The children may or may not relate to adults, but that is not the reason for including the play area. Cognitive ability is only one of the areas of assessment, and not the overall reason for including the play area. Toys may or may not be specific to the childs biological age.The parents of a child with a spectrum disorder are asking the nurse about what kind of social expectations are realistic for their child. Which of the following is the overall outcome for a child diagnosed with a spectrum disorder? 1. To acknowledge the effects of ones own behavior on others 2. To function more effectively in social and emotional interactions 3. To stay on task 4. To acknowledge personal strengths2. Autism spectrum disorders involve difficulties in the quality of both the social interaction and the communication of the child. In social interaction, the child may have problems making eye contact, fail to develop appropriate peer relationships, fail to spontaneously seek out shared enjoyment with other people, or show no social or emotional reciprocity. Children with spectrum disorders may or may not be able to acknowledge the effects of their behavior on others, stay on task, or acknowledge personal strengths.The school nurse recommends that the parents of a student seek help because the student is constantly in trouble and recently has set several small fires on school grounds. The nurse is concerned because the child is manifesting signs of: 1. Conduct disorder. 2. Depression. 3. Oppositional defiant disorder. 4. Attention deficit hyperactivity disorder.1. Children with a conduct disorder are more likely to fight, steal, vandalize, or have school problems. These are not signs of depression; however, the child with a conduct disorder may also be depressed. The most distinctive features of attention deficit hyperactivity disorder (ADHD) are the childs inattention to the surrounding environment and hyperactivity and/or impulsiveness. The child with an oppositional defiant disorder may show low self-esteem, minimal frustration tolerance, swearing, mood lability, and precocious use of tobacco, alcohol, or illegal drugs.In working with a preschool-age child, which intervention would be considered as part of an effective plan for time-outs? 1. Identify in advance, situations that lead to anger 2. Explanations are not important to the child who is out of control 3. Length of time depends upon how long it takes the child to calm down 4. Incorporate a token economy3. When children cannot behave in acceptable ways, they can take a time-out from the activity by sitting in a chair until they are able to pull themselves together. The use of behavioral interventions on inpatient units allows nursing staff to give continuous feedback to the children about the appropriateness of their behavior. As the child calms down, help the child see why the time-out was needed and what can be done differently next time. The goals are to have children learn what precedes episodes during which they lose control and learn ways to avoid the negative consequences of out-of-control behavior. Such behavior may or may not be anger-oriented. A token economy is not part of time-out planning.The nurse works with both the child and parents to help the child develop interpersonal skills. Which of the following general outcomes facilitates engaging the parents in the process? 1. Increasing knowledge of the childs psychopathology 2. Understanding the childs unique temperament and needs 3. Responding to separation anxiety 4. Administering PRN medications effectively2. A general outcome is for the parents to develop a better understanding of the childs unique temperament and needs. The significance of this outcome is that as they work with the nurse to improve a childs interpersonal skills and become a more active social partner, the child should begin to engage the parents and respond in ways that reward their caregiving. Engaging the child in interpersonal skills will not facilitate the parents ability to perform the specific functions of administering PRN medications effectively, responding to separation anxiety, or understanding of the child psychopathology.The new stepfather of a child diagnosed with a conduct disorder wants to know the reason for including him in family therapy sessions. The nurse explains that the goal of family therapy is to: 1. Increase the probability that the childs mental health will improve. 2. Help the child relive past events and related feelings. 3. Provide an opportunity for the parents to interact with their child in a safe environment. 4. Speak for the child so the parents can become more aware of the childs potential.1. The goal of family therapy is to increase the likelihood that improvements in the childs mental health will occur. Involving step-parents in family therapy builds support in the home for these gains with consistent and sustained family patterns. The nurse uses modeling as an intervention to demonstrate specific ways of interacting with the child, to suggest approaches for the parents to try, to use positive interactions, and to speak for the child so the parents become more aware of the childs potential experience during caregiving. Abreaction, the reliving of past events and related feelings, is one of the purposes of play therapy. Providing a safe environment for interaction is another aspect of increasing the likelihood that improvements will occur. It is not a goal of family therapy for the nurse to speak for the child.A client, age 8, has just been prescribed pemoline (Cylert). The childs parents ask about the long-term effects of this medication. The nurse conducting patient teaching for the parents about this medication will include which of the following statements? 1. Photosensitivity is a problem with long-term use. 2. This is one of the drugs found to be safe for long-term use. 3. At the present time, there is limited information about this. 4. There seems to be a better outcome when the higher dose is given at bedtime.3. There is limited information on the long-term effects of stimulants or the impact of treatment when the child is on medication for 10 years or more. This medication is used to treat attention deficit disorder and should be given in the morning to prevent problems sleeping at night.The charge nurse is assigned a float nurse to help on the childrens unit. The nurse normally works with adults and says she feels out of place working with the children. In making the assignments, which of the following activities would the charge nurse NOT assign to the float nurse? Select all that apply. 1. Administering daily medications 2. Administering PRN medications 3. Obtaining vital signs 4. Making rounds with the psychiatrist 5. Monitoring the children under close observation1, 2, 4, 5 This nurse is not familiar with the children in terms of their medications, dosages, and at-risk behaviors. The nurse should not be assigned to perform functions with a high potential for errors in judgment and safety with an unfamiliar population. These functions include administering medications (PRN or otherwise) and monitoring a group of children under close observation. Since the nurse is not familiar with the issues, needs, and progress of the children, making rounds with the psychiatrist may be counterproductive. In this instance, the nurse should be given some time to orient to the childrens unit.The nurse administering a lithium carbonate (Lithobid) to a child with mental retardation monitors the child for which of the following therapeutic effects? 1. Weight loss 2. Decreased agitation 3. Weight gain 4. Elevated mood2. Lithium carbonate (Lithobid) is the mood stabilizer used with children. Its primary use in clients with mental retardation is for severe aggression and agitation rather than for managing mania. A side effect of the medication is weight gain. Elevated mood and weight loss are not therapeutic effects of lithium carbonate (Lithobid).When caring for children in the mental health setting, nurses may become aware of unresolved issues about their own family. If left unaddressed, care for the child may be affected because: 1. This experience should not affect nurses. 2. There is an increased potential for regression. 3. This opportunity will help the nurses heal. 4. Nurses feelings may become activated.4. It is important that nurses working with children, particularly children with emotional problems, practice self-awareness. These experiences may activate feelings about ones own unresolved issues with the nurses family of origin or current family and may affect the ability to provide therapeutic care. If the feelings are activated, the nurse may have an opportunity to heal or may experience regression.A nurse caring for a child is concerned about remaining therapeutic when working with a child with anger management issues. Which of the following must the nurse avoid in order to remain therapeutic? 1. Examining personal feelings about the child 2. Reflecting back on a situation 3. Projecting his/her feelings onto the child 4. Sharing his/her concerns with peers and colleagues3. Projecting is an ego defense mechanism whereby one places the undesirable behavior onto another. Projecting personal feelings onto the child who feels or acts in ways the nurse might have felt or acted affects the nurses ability to respond to the childs actual therapeutic needs. The other choices are acceptable behaviors.Self-awareness is an important aspect of nursing practice in any specialty. Which of the following questions would the nurse ask to build self-awareness when working with child psychiatric clients? Select all that apply. 1. What dont I like about this child? 2. How can I use this opportunity to learn more about myself? 3. What am I learning about myself as I work with this child? 4. How do I avoid working with the parents?1, 2, 3 All of the questions apply to developing self-awareness except avoiding working with the parents; parents need to be involved in order for treatment to progress. Asking, What am I learning about myself as I work with this child? and What dont I like about this child? are necessary to help one examine thoughts and feelings which contribute to self-awareness. Asking, How can I use this opportunity to learn more about myself? is necessary for personal growth.