Emily recently started third grade but is struggling academically. Her teacher has noted that Emily often appears distracted and reluctant to participate in group activities. She has also expressed feelings of embarrassment when her peers discuss sleepovers, as she avoids attending them.
Emily’s mother describes her as an "anxious child" who worries excessively about school and friendships. The family recently moved to a new neighborhood, and Emily had difficulty adjusting to the changes. She has no significant medical history, and a thorough physical examination and urinalysis ruled out any organic causes for the enuresis.
The pediatrician referred Emily to a Psychiatric/Mental Health NP for further evaluation. During therapy, Emily disclosed that she feels pressure to meet high expectations at school and struggles to make friends. She also revealed that her parents argue frequently at home, which makes her feel scared and unsure how to express her feelings.
The PMHNP diagnosed Emily with generalized anxiety disorder (GAD), and the treatment plan includes cognitive-behavioral therapy (CBT), relaxation techniques, and continued monitoring of her enuresis. Emily and her family are also being educated on how stress and anxiety can exacerbate bedwetting.
Questions:
1. Which factor in Emily’s case is likely contributing to her enuresis?
a) Urinary tract infection
b) High caffeine intake
c) Stress and anxiety
d) Poor diet
2.Which therapy is recommended to help Emily cope with her anxiety?
a) Exposure therapy
b) Cognitive-behavioral therapy
c) Dialectical behavior therapy
d) Hypnotherapy
3. Why is family education important in Emily’s treatment plan?
a) To foster a supportive home environment
b) To blame the family for her condition
c) To eliminate the need for therapy
d) To ensure punishment is applied consistently
ANSWERS:
1. c
2. b
3.a