Chapter 15: Mental Health Promotion and Behavioral Concerns

Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition

MULTIPLE CHOICE

1. A parent who encourages competitiveness in a child who excels at a single sport but not in
others may also encourage a sense of which characteristic?
a. Competence
b. Insecurity
c. Significance
d. Worthiness
ANS: B
Children who gain praise for external measures, such as performance of a sport, may end up
unduly comparing themselves with others and feel insecure, inferior, and inadequate, even as
they continue to excel in this sport. Competence comes from feeling capable and confident
and able to approach new tasks. Significance comes from having a sense of belonging and
being accepted unconditionally; this child’s self-worth is dependent on performance in a sport.
Worthiness is based on an understanding of having a purpose in life and is also unconditional.

2. A school-age child enjoys playing basketball but doesn’t make the intramural team. Which
response by the child is characteristic of the concept of a growth mindset?
a. “I didn’t play well on the day of the tryouts.”
b. “I’ll just have to find another sport I’m good at.”
c. “I’ll need to work more on my outside shot.”
d. “I’m probably too short to be really good at this sport.”
ANS: C
Children who have a growth mindset have been taught to believe that hard work is key to
success and that effort and practice contribute to growth. By not being discouraged and
identifying something to work on, the child is exhibiting a growth mindset. Saying that he
didn’t play well is making excuses, while stating he needs to find something else he’s good at
or blaming his failure on a physical characteristic indicates a belief that success is dependent
on fixed traits.

3. The primary care pediatric nurse practitioner is evaluating a 16-year-old adolescent male who
is on the high school wrestling team and whose weight fluctuates as much as 7 or 8 pounds
before matches. The child is eager to talk about the various trophies he has won. When he
expresses confidence that he will get a wrestling scholarship for college, his father remarks
that his grades will never be good enough for college, causing him to blame his teachers. The
nurse practitioner may identify potential problems with what process?
a. Body image
b. Personal identity
c. Role performance
d. Self-esteem
ANS: D
 Children with poor self-esteem seek attention, importance, and security and may become self-
absorbed with external markers of self-worth, such as performance in a sport. Another mark of
insecurity is defensiveness, which this child exhibits by blaming his teachers for his poor
grades. Children with body image problems become overly concerned with appearance and
compare themselves to others. This child is losing and gaining weight to be better at wrestling,
not to look different. Children with personal identity issues internalize negative perceptions of
others and manifest feelings of inferiority. Children with role performance problems feel
incompetent and are hesitant to try new things or become perfectionists to overcompensate.

4. The primary care pediatric nurse practitioner sees a 10-year-old child whose parent describes
as a “class clown.” The child denies having problems at school, but acknowledges poor grades
by saying, “I’m not very smart, I guess.” When counseling the parent about helping this child
deal with this self-perception issue, the nurse practitioner will recommend which strategy?
a. Empower the child to make decisions and assume more responsibilities.
b. Help the child identify skills and activities that he is good at.
c. Spend time each evening helping the child with homework to improve grades.
d. Work with the teacher to set appropriate limits on school behavior.
ANS: B
This child exhibits problems with personal identity and copes by clowning around to avoid
dealing with problems of inferiority about school performance. The parent should work with
the child to find areas of strength and help the child become accomplished in those things to
improve self-esteem.

5. The primary care pediatric nurse practitioner is performing a well child examination on a
fussy toddler who has red hair. The child’s parent tells the toddler to stop being fussy and
says, “red hair gives him such a temper.” Which common error that erodes self-esteem is this?
a. Dwelling on negatives
b. Expecting too much
c. Negating the child’s feelings
d. Stereotyping and typecasting
ANS: D
The parent is typecasting the child by associating having a temper with the trait of red hair,
which can limit his sense of possibilities. Dwelling on negatives describes making critical
remarks instead of positive remarks. A parent who expects too much creates pressures for
behaviors that are beyond the reach of the child and makes the child feel inadequate. Negating
feelings is a rejection of the child’s emotions.

6. The primary care pediatric nurse practitioner is performing an examination on a 2-year-old

child who has been placed in emergency foster care with a grandparent after the child’s
mother has been arrested for drug use. The child has a history of asthma with frequent
exacerbations because of parental smoking. What is a priority for the nurse practitioner at this
visit?
a. Evaluation of financial resources, medical insurance, and access to health care and
medications
b. Providing a list of websites and community-based support groups for grandparents
parenting grandchildren
c. Referral to a social worker to help the child deal with emotional conflict related to
separation from the parent
 d. Teaching the grandparent about the need for consistency in routines and discipline
for the child
ANS: A
A high percentage of grandparents who parent grandchildren have financial difficulties and
most cannot claim grandchildren as dependents for health care. This child has a chronic
disease and will need medication and possibly hospitalization, so the PNP should assess
resources and access to care. The other options are important but are not a priority in the
initial visit.

7. During a well child examination on an infant who has colic, the primary care pediatric nurse
practitioner learns that the infant’s mother is 17 years old and that the father, who is in the
military, was deployed to wartime duty shortly after the baby was born. To determine the
immediate risk of child maltreatment for this infant, the nurse practitioner will ask about
topic:
a. childrearing and parenting styles.
b. role responsibilities of the parents.
c. spiritual beliefs and religious practices.
d. the location of extended family members.
ANS: D
Assessment of resources, including the support of extended family members, is a key
dimension of family functioning. In this case, the mother is young and alone and may lack the
skills needed to cope with an infant with colic. Childrearing and parenting styles can affect the
emotional and physical health of children who misbehave or who are learning how to behave
in the world. An assessment of role responsibilities is important when there are disagreements
about shared responsibilities. Assessing spiritual beliefs helps to determine the values ascribed
to events. While all of these are important assessments, there is an urgent need to determine
the level of support available to this mother.

8. The parent of a preschool-age child who is diagnosed with a sensory processing disorder
(SPD) asks the primary care pediatric nurse practitioner how to help the child manage the
symptoms. What will the nurse practitioner recommend?
a. Establishing a reward system for acceptable behaviors
b. Introducing the child to a variety of new experiences
c. Maintaining predictable routines as much as possible
d. Providing frequent contact, such as hugs and cuddling
ANS: C
Children with SPD do best with an environment that is predictable and routine and the same
from day to day. Discipline and/or a reward system is not effective. Children with SPD can
become overwhelmed by new experiences or frequent touch.

9. The primary care pediatric nurse practitioner is counseling a family whose parents are
divorcing. To help support the children and reduce their stress through this process, what will
the nurse practitioner recommend?
a. Allowing children to choose the custodial parent
b. Being open about ongoing parental conflicts
c. Establishing a single custody living arrangement
d. Maintaining a civil relationship when discussing children
 ANS: D
Children make more successful adjustments and suffer less stress when parents are able to
develop a civil relationship that focuses on what is best for them. Custody arrangements vary
and may change over time and should be determined by what is best for the children. Custody
disputes and exposure to parental conflict place additional stress on children and can increase
their feelings of insecurity.

10. The primary care pediatric nurse practitioner learns that a school-age child continues to hope
that his parents will remarry 1 year after they have divorced. What will the nurse practitioner
tell this child’s parents?
a. “If one of you remarries, he is more likely to understand that this is permanent.”
b. “This is a normal response and is an expression of hope that things will be OK.”
c. “You will need to help him accept the reality of the permanence of the divorce.”
d. “Your child is most likely blaming himself for your separation and divorce.”
ANS: C
Accepting the permanence of the divorce is one of the psychological tasks children of divorce
must master in order to master normal developmental tasks. Parents need to focus on helping
the child achieve these tasks. A remarriage does not necessarily help the child to achieve this
task. It is a sign that the child cannot accept the reality of the situation, not of hope, and does
not indicate self-blame.

11. The parent of an adolescent female tells the primary care pediatric nurse practitioner that the
child may be the victim of cyber-bullying at school but won’t talk about it with her parents.
What is the nurse practitioner’s initial response?
a. Ask about the adolescent’s school performance and friends.
b. Interview the adolescent separately from the parent.
c. Reassure the parent that suicide is a rare response to bullying.
d. Suggest that the parent discuss this with the school counselor.
ANS: B
When bullying is suspected, it is ideal to interview the youth separately from the parent, even
though it is necessary to get the history from both, since children are often reluctant to discuss
bullying with their parents. Asking about school performance and friends is part of the history
but not a priority. Reassuring the parent that suicide is rare minimizes the parent’s concerns.
Suggesting that the parent discuss this with the school shows an unwillingness to consider the
problem as part of the child’s overall health.