Pediatric Nurse Psychosocial and Mental Health Questions and Answers — Questions and Answers
Question 1: A 15-year-old is brought to the clinic by a parent who is concerned about their recent behavior, including a persistent irritable mood, loss of interest in soccer, significant weight loss, and difficulty concentrating on schoolwork for the past month. The nurse should anticipate screening the adolescent for which of the following conditions first?
- Anorexia nervosa
- Generalized anxiety disorder
- Major depressive disorder (Correct answer)
- Attention-deficit/hyperactivity disorder (ADHD)
Correct answer: Major depressive disorder
The constellation of symptoms including persistent irritable mood, anhedonia (loss of interest), significant weight change, and diminished ability to concentrate, lasting for at least two weeks, are hallmark signs of major depressive disorder in adolescents. While symptoms may overlap with other conditions, the combination and duration strongly point towards depression as the primary concern to screen for.
Question 2: A nurse is providing care for a 7-year-old child recently diagnosed with ADHD, inpatient for a femur fracture. Which nursing intervention is most appropriate to include in the child's plan of care to address their psychosocial needs related to ADHD?
- Minimizing all forms of stimulation in the room to prevent hyperactivity.
- Providing long, detailed explanations of procedures to ensure understanding.
- Maintaining a highly flexible schedule to accommodate the child's impulses.
- Implementing a structured daily routine with frequent, short breaks during activities. (Correct answer)
Correct answer: Implementing a structured daily routine with frequent, short breaks during activities.
Children with ADHD thrive on predictability and structure. A consistent daily routine helps manage expectations and reduce anxiety. Incorporating frequent, short breaks can help maintain focus and prevent the child from becoming overwhelmed or overly fatigued during tasks, which is a key strategy for managing ADHD behaviors in various settings, including a hospital.
Question 3: Which of the following is a key feature that helps a nurse differentiate a manic episode in pediatric bipolar disorder from the typical presentation of ADHD?
- The presence of hyperactivity and impulsivity.
- The chronic and persistent nature of the symptoms.
- The episodic nature of the mood changes. (Correct answer)
- The child's difficulty with peer relationships.
Correct answer: The episodic nature of the mood changes.
The primary distinguishing feature between pediatric bipolar disorder and ADHD is the pattern of symptoms. In bipolar disorder, symptoms like irritability, high energy, and poor judgment occur in distinct episodes (mania or hypomania) that are a change from the child's usual baseline. In contrast, the symptoms of ADHD, such as hyperactivity and inattention, are chronic and persistent across various settings and do not typically cycle in discrete episodes.
Question 4: A nurse is conducting a well-child visit for a 16-year-old female. The nurse notes a BMI of 16.5, fine lanugo hair on the back and arms, and reports of feeling cold frequently. The adolescent denies any problems and states she is 'just trying to be healthy.' Which of the following conditions should the nurse be most concerned about?
- Bulimia nervosa
- Anorexia nervosa (Correct answer)
- Avoidant/Restrictive Food Intake Disorder (ARFID)
- Binge eating disorder
Correct answer: Anorexia nervosa
The combination of significantly low body weight (indicated by the low BMI), physiological signs of malnutrition like lanugo and feeling cold (due to loss of insulating body fat), and a distorted body image or denial of the seriousness of low weight are classic signs of anorexia nervosa.
Question 5: During a routine check-up for a 24-month-old, the nurse uses the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R). This screening tool is designed to identify children at risk for which of the following?
- Speech and language delays
- Social anxiety disorder
- Global developmental delay
- Autism spectrum disorder (Correct answer)
Correct answer: Autism spectrum disorder
The M-CHAT-R is a validated parent-report screening tool specifically designed to assess a toddler's risk for autism spectrum disorder (ASD). It asks questions about specific social and communicative behaviors that are characteristic of ASD, facilitating early identification and referral for diagnostic evaluation.
Question 6: A pediatric nurse is providing education to the parents of a child diagnosed with Autism Spectrum Disorder (ASD). Which statement by the parents indicates an effective understanding of nursing guidance?
- "We should avoid all routines to help our child become more flexible."
- "It's best to use long sentences and metaphors to expand their language."
- "Maintaining a predictable schedule and using visual aids can help reduce our child's anxiety." (Correct answer)
- "We will try to make our child look us in the eye whenever we speak to them."
Correct answer: "Maintaining a predictable schedule and using visual aids can help reduce our child's anxiety."
Individuals with ASD often experience significant anxiety with changes and transitions. Providing a structured, predictable environment and using visual supports (like picture schedules) are evidence-based strategies that enhance communication, reduce challenging behaviors, and promote a sense of security.
