# A school nurse is assessing a 15-year-old student who has been referred for possible bullying victimization. Which assessment finding would be the MOST significant indicator that the student is experiencing bullying? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543455 > language: ko > subject: Mental Health ## 문제 A school nurse is assessing a 15-year-old student who has been referred for possible bullying victimization. Which assessment finding would be the MOST significant indicator that the student is experiencing bullying? ## 보기 1. The student reports that classmates frequently exclude them from group activities, call them names, and threaten harm if they tell anyone. **✔ 정답** 2. The student has difficulty concentrating in class and their grades have declined slightly over the past month. 3. The student appears withdrawn during the assessment and avoids eye contact with the nurse 4. The student's parents report that the child has been reluctant to go to school for the past week **정답: 1** ## 해설 Direct reports of specific, repeated aggressive behaviors like exclusion, name-calling, and threats are the most significant bullying indicators. Other options are secondary symptoms less specific to bullying. ## 심화 해설 Correct Answer: 1 The most significant indicator of bullying victimization is the student's direct report of being systematically targeted through exclusion, verbal harassment, and threats of harm if they disclose the abuse. This finding aligns with the core definitional components of bullying, which the literature identifies as intentionality, repetition, and a power imbalance. According to the systematic review by Muñoz et al., bullying is characterized by intentionality and persistence over time, distinguishing it from isolated peer conflicts [2]. The student's statement explicitly describes a pattern of repeated, intentional harm where the perpetrators leverage social power to isolate and intimidate, which is the clinical hallmark of victimization. The psychometric framework of the revised Olweus Bully/Victim Questionnaire (OBVQ-R) further supports why this direct verbalization is the most significant finding. The OBVQ-R is designed to capture the specific behavioral manifestations of bullying, including verbal abuse, social exclusion, and threats, as these are measurable and defining features of the victimization construct [1]. When a student articulates these experiences, it provides high-specificity data that directly maps onto validated screening criteria. This is more diagnostically significant than secondary signs, which can be nonspecific and arise from a multitude of adolescent stressors. Research confirms that bullying victimization is a distinct psychosocial stressor that serves as a key mediating mechanism linking early adversity to later internalizing problems, making its direct identification critical for accurate assessment and intervention [3]. The remaining options represent secondary or nonspecific manifestations that, while clinically relevant, lack the specificity required to identify bullying as the primary etiology. A decline in academic concentration and grades (Option 2) is a common consequence of the emotional distress associated with victimization, as bullying negatively impacts cognitive and emotional resources . However, academic deterioration is a broad marker for numerous adolescent issues, including depression, anxiety disorders, or family stress. Similarly, appearing withdrawn and avoiding eye contact (Option 3) is a behavioral manifestation of the negative emotions and diminished self-esteem that frequently result from being bullied [2,4]. Reluctance to attend school (Option 4), reported by parents, is a significant red flag for school avoidance, which is strongly associated with bullying. Yet, this parental observation is a proxy indicator; it reflects the behavioral output of the child's distress but does not confirm the cause. The student's own detailed disclosure of victimization provides the direct, criterion-standard evidence needed to establish that bullying is the underlying mechanism driving these secondary signs. The mediation models in the literature demonstrate that bullying victimization leads to negative emotions and interpersonal difficulties, which then manifest as these observable behaviors . Therefore, while findings 2, 3, and 4 should raise suspicion and prompt further investigation, they are downstream effects, whereas finding 1 identifies the root cause.References (research sources) - [1]Psychometric evaluation of the revised Olweus Bully/Victim Questionnaire in Japanese adolescents.Research articleZain E, Sugimoto A, Kasahara H, Yoshinaga K, Ootake M, Kuwana Y, Parawansa FBP, Watanabe Y, Fukui N, Egawa J, Boku S. (2026) · DOI: 10.3389/fpubh.2026.1812071 - [2]Effectiveness of School-Based Psychoeducational Program in Reducing Bullying and Improving Self-Esteem: A Systematic Review.Meta-analysis/systematic reviewMuñoz MB, Zafra-Agea JA, Marco EM, Flores-Saldaña M, Vera-Remartínez EJ, Esteve-Clavero A, Molés-Julio MP. (2026) · DOI: 10.3390/healthcare14030330 - [3]Childhood emotional abuse and adolescent anxiety: a moderated mediation model of bullying victimization, perceived teacher legitimacy, and negative legal emotion.Research articleWang S, Sun W, Hong Z, Huang H, Xu S. (2026) · DOI: 10.3389/fpsyg.2026.1803574 ## 임상 시나리오 Identifying Bullying in the School Health SettingDirect Report as the Most Specific Clinical Indicator The most significant indicator of bullying victimization is the student's direct verbal report of being systematically targeted. This report must include the three core features: intentionality, repetition, and a power imbalance. Specific behaviors to ask about include social exclusion, verbal harassment (name-calling), and threats of harm used to enforce silence. These map directly onto validated screening tools like the Olweus Bully/Victim Questionnaire (OBVQ-R). CautionDo not rely on nonspecific secondary signs alone, such as a slight grade decline, appearing withdrawn, or one week of school reluctance. These can arise from multiple adolescent stressors and lack the diagnostic specificity of a direct disclosure of repeated, targeted aggression. ## 핵심 개념 - **Bullying** — Unwanted, aggressive behavior among school-aged children that involves a real or perceived power imbalance and is repeated, or has the potential to be repeated, over time. - **Victimization** — The process of being subjected to a crime, harmful act, or unfair treatment; in this context, being the target of bullying behaviors. - **Olweus Bully/Victim Questionnaire (OBVQ-R)** — A validated psychometric tool designed to measure specific behavioral manifestations of bullying and victimization, including verbal abuse, social exclusion, and threats. - **Power Imbalance** — A defining component of bullying where the aggressor uses actual or perceived power—such as physical strength, popularity, or access to embarrassing information—to control or harm the victim. - **Intentionality** — A core feature of bullying indicating that the harmful behavior is deliberate and not accidental, distinguishing it from isolated peer conflicts or misunderstandings. ## 같은 주제 문제 - [A school nurse is assessing a 14-year-old student who has been referred for possible bully…](https://mymerci.kr/pages/nclex_q.php?qn_id=543454) - [What is the most appropriate initial nursing intervention for a student experiencing cyber…](https://mymerci.kr/pages/nclex_q.php?qn_id=543456) - [A 16-year-old student has been experiencing persistent bullying at school for the past 3 m…](https://mymerci.kr/pages/nclex_q.php?qn_id=543457) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._