A grade school nurse is conducting vision screening before school and notes the student is accompanied by an older sister who has also brought a middle school child

Question

The older child states that time is a problem because middle school starts in a few minutes and tells the younger child to go right to the classroom after the screening, then leaves. What question by the nurse would be most appropriate to ask the youngest child during the screening?
A.
"Do you feel safe at home or is someone hurting you there?"
B.
"Does your sister always bring you and your sibling to school?"
C.
"Have you ever seen your parents drinking a lot or using drugs?"
D.
"Why aren't your parents available to bring you to school?"

Answer 1

ANS: B
In substance-abusing families, one child often takes the role as the responsible person, allowing the family to continue functioning. The fact that a sibling was bringing the children to school is a little unusual, and the nurse should assess the reason behind it. However, substance-abusing families often keep secrets for both social and legal reasons. The nurse should not ask directly about substance abuse, but rather open a line of discussion by introducing a nonthreatening question. There is no indication of abuse, so asking if the child is safe is not appropriate at this time. In a secret-keeping family, asking directly about drinking or drug use would most likely elicit a negative response. Asking "why" questions is confrontational.