A grade school nurse is conducting vision screening before school and notes the student is ...

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.