Walden NURS6660 Midterm 2019 Question # 00601901 Course Code : NURS6660 Subject: Health Care Due on: 06/03/2019 Posted On: 06/03/2019 04:02 AM Tutorials: 1 Rating: 4.6/5

Question 1

Which of the following statements is true with respect to
children who present to care acutely due to violent, enraged behavior?

A.

Under no circumstances should the PMHNP approach this
patient.

B.

Prepubertal children typically require medication as they
are too young to respond to conversation.

C.

Children who have a history of repeated, self-limited,
severe tantrums require at least a 72-hour admission.

D.

If the child appears to be calming down in the emergency
area, the clinician may ask the child for his version of events.

Question 2

Phillip is a 5-year-old boy who is in care after being
referred for failure to speak at school. He has been in kindergarten for 5
months, and initially his teacher thought he was just shy, so she did not focus
on him. However, it has become increasingly apparent that he flat out will not
speak at school. Phillip’s parents are adamant that there is not any problem at
home and that Phillip talks with them and his older sister routinely. Further
assessment reveals that he has always been extremely shy and that he doesn’t
like it when people make a fuss over him. The PMHNP suspects that Phillip has
selective mutism, which is closely related to:

A.

A history of sexual abuse

B.

Fetal alcohol syndrome

C.

Early onset schizophrenia

D.

Social anxiety disorder

Question 3

Jason is a 17-month-old male who is referred for evaluation
of an unusually high level of irritability. His mother says he cries ?all the
time,? and sometimes he just cannot be comforted; Jason’s pediatrician felt
that the complaint warranted an evaluation by child psychiatry. Comprehensive
assessment of Jason’s irritability should include all the following except:

A.

A comprehensive medical assessment

B.

Standardized developmental measures

C.

Assessment without the parents present

D.

Observation of Jason during play

Question 4

Treatment of abused children is multimodal and long term.
The single most important aspect of treatment is:

A.

Establishing a safe place for the child

B.

Exposure related to the feared experience

C.

Psychoeducation

D.

Cognitive-behavioral interventions

Question 5

Having child and adolescent patients rate their feelings and
moods on a scale of 1–10 is most effective in which age group?

A.

18-months to 3 years

B.

3 to 5 years

C.

5 to 11 years

D.

12 to 17 years

Question 6

The PMHNP is evaluating his data for the assessment of Eric,
a 23-month-old male who was referred because he is having nightmares to the
extent that most nights he is waking up family members with his crying and
screaming. In addition to the clinical interview with the parents and patient,
developmental assessment, and standardized tools, the assessment should
include:

A.

Review of a video recording of a nightmare event and Eric’s
immediate response

B.

Age-appropriate interview, e.g., ?If you had three wishes,
what would they be??

C.

Observation of Eric in a playroom where he is unaware that
he is being watched

D.

Partially open-ended questions that provide some focus but
allow expression of feeling

Question 7

What is the primary diagnostic difference between
obsessive-compulsive disorders in children as compared to adults?

A.

Age of onset

B.

Response to treatment

C.

Recognition that the thoughts or behaviors are irrational

D.

The thoughts or behaviors occupy > 1 hour daily

Question 8

Psychiatric assessment of children and adolescents is best
achieved by a combination of tools and techniques best suited to the child’s
age and developmental stage. When interviewing a 10-year-old, the PMHNP may
have the best success by having the patient:

A.

Talk with the examiner via dolls

B.

Respond to open-ended questions

C.

Draw family members and peers

D.

Complete an MMPI

Question 9

The clinical interview is an important part of psychiatric
assessment and should be conducted early in the diagnostic process. However, a
comprehensive assessment should include other information-gathering modalities
because the clinical interview:

A.

Does not offer flexibility in understanding the evolution of
the problem

B.

Frequently deemphasizes the influence of environmental
factors

C.

May not systematically cover all psychiatric diagnostic
categories

D.

Creates a dialogue in which patients cannot give subjective
responses

Question 10

Comprehensive psychiatric assessment ultimately requires the
integration of biological predisposition, psychodynamic factors, environmental
factors, and life events. These factors, along with a mental status exam,
developmental assessment, and any appropriate standardized testing is
collectively referred to as:

A.

Neuropsychiatric assessment

B.

Biopsychosocial formulation

C.

The Physical and Neurological Examination of Soft Signs
(PANESS)

D.

Kaufman Assessment Battery for Children

Question 11

Caleb is a 10-year-old boy who is referred for assessment
because he is not following any of the rules of discipline at home. His parents
report that they have had three separate nannies resign in the last 4 months
because Caleb is unmanageable. This is a long-standing problem, going back to
daycare even before kindergarten. The PMHNP knows that when conducting her
initial interview of Caleb she should:

A.

Anticipate that he can tolerate up to a 45-minute session

B.

Consider that symbolic play with dolls will be informative

C.

Interview him alone before involving the parents

D.

Be clear that he is there because of problem behavior

Question 12

Comprehensive psychiatric/mental health assessment of
children includes an interview with the parents or caregivers. Which of the
following is not a true statement with respect to the parental interview?

A.

The parents’ own emotional adjustments should be determined.

B.

The parents are usually more aware of symptoms than the
child.

C.

The parents may prefer to speak with the PMHNP separately.

D.

The parents’ upbringings are relevant to the child’s
diagnosis.

Question 13

Karen is a 7-year-old girl who has been started on
atomoxetine 18 mg once daily for ADHD, which is just under the recommended
starting dose of 0.5 mg/kg/day. After just 1 week, her parents report that she
is not eating, complains of stomach pain almost every day, is having trouble
sleeping, and is ?really cranky.? Her teacher says she never seen anything like
it; that Karen is actually worse on her ADHD medication. A careful review
reveals that Karen is taking her medication just as prescribed. She is not on
any other prescribed, over-the-counter, or herbal medications. The PMHNP
considers that:

A.

These are common in the first weeks of therapy and the dose
should be increased to a therapeutic regimen

B.

Karen may be a poor metabolizer of CYP2D6 medications and
will need a change of therapy

C.

Behavioral modalities should be started as optimal
management of ADHD is multimodal

D.

Fluoxetine should be added to the regimen as it has
demonstrated efficacy with coincident anxiety

Question 14

When treating anxiety disorders in young children, cognitive
behavioral therapy (CBT) is preferred as initial treatment if the child is able
to function sufficiently to engage in daily activities while in treatment.
Which of the following therapies is appropriate for those children too young to
engage in traditional CBT?

A.

Selective serotonin reuptake inhibitors (SSRI)

B.

SSRI in combination with CBT

C.

Coaching Approach behavior and Leading by Modeling (CALM)

D.

CALM in combination with a first-generation antihistamine

Question 15

Adam is a 26-month-old boy referred by his pediatrician for
evaluation of speech delay. He has not spoken any intelligible words. Adam is
an only child, and the parents deny any contributory medical history. Adam was
delivered at 38 weeks 5 days’ gestation without complication. At 5 weeks of age
he developed respiratory failure due to respiratory syncytial virus (RSV) and
was hospitalized on a ventilator for several days; since then, the parents
report only the occasional upper respiratory virus. They report that Adam is a
?really good? child and will often entertain himself for periods of time with
his building blocks; rarely he will have a ?temper tantrum.? The parents
confirm that Adam does not speak any recognizable words. While he does make
sounds, his parents admit that he does not appear to be trying to communicate
with them. When considering a diagnosis of autism spectrum disorder (ASD), the
PMNHP would expect further history and examination to reveal:

A.

The presence of imaginary play

B.

A failed hearing test

C.

Exaggerated response to minor injury

D.

Notable decrease in attachment behaviors

Question 16

Comprehensive psychiatric assessment of young school-aged
children requires a variety of information sources. Input is necessary from
parents, caregivers, and teachers because children of this age group cannot
reliably provide information about:

A.

Their own fears and anxieties

B.

Psychotic episodes they have experienced

C.

The chronology of symptom presentation

D.

Episodes of mood extremes

Question 17

Mark is a 5-year-old boy brought in for evaluation because
his behavior at school has become so disruptive. According to the parents,
Mark’s teacher says he just refuses to follow the rules of the classroom,
openly defies her, and actually seems to try and upset his classmates. The
teacher says Mark gets frustrated very easily when he cannot complete a task
and is resistant to any effort to help him. This happens almost every day, and
the teacher has indicated that she will not be able to keep him in the classroom
if things do not change. Mark’s parents admit that he has always been ?willful?
and difficult to manage, but as he is an only child with a stay-at-home mom,
the family overlooked his disruptive tendencies and accommodated Mark. The
parents report that they often skip social events and family outings because
they don’t know how Mark will behave. While counseling Mark’s parents about the
theories of causation of oppositional defiant disorder (ODD), the PMHNP tells
the parents that psychiatric theories include all of the following except:

A.

Unresolved conflict as a fuel for aggressive behavior
targeting authority figures

B.

The concept that oppositionality is a reinforced, learned
behavior in which the child exerts control over authority figures

C.

A maladaptive response to parents’ modeling of conflict
avoidance as manifested by even-tempered responses to parent-toddler struggles

D.

That the behavior is reinforced by increased parental
attention in response to the undesirable behavior

Question 18

Trauma-focused cognitive behavior therapy is a CBT approach
characterized by 10–16 sessions comprised of four components: (1)
psychoeducation, (2) stress inoculation, (3) gradual exposure, and (4)
cognitive reprocessing. This is a management strategy for post-traumatic stress
disorder (PTSD) that is:

A.

Most effective when paired with eye movement desensitization
and reprocessing (EMDR)

B.

Considered by experts to be the first-line management
approach for treatment of PTSD symptoms

C.

Very effective in individuals but generally not recommended
for group treatment, e.g., school-based traumas

D.

Gaining widespread acceptance as a first-line management
strategy for other forms of anxiety disorders

Question 19

Being Brave: A Program for Coping With Anxiety for Young
Children and Their Parents is a manualized intervention for anxiety disorders
in young children between the ages of 4 and 7 years old. It uses a combination
of parent-only and parent-child sessions and demonstrates significant
improvement in children with all forms of anxiety disorders except:

A.

Separation anxiety

B.

Social anxiety

C.

Generalized anxiety

D.

Specific phobia

Question 20

During the mental status exam of Oliver, a 4-year-old child,
the PMHNP appreciates that he appears to be having transient visual and
auditory hallucinations. The PMHNP knows that the best approach to this finding
is to consider that:

A.

This is most consistent with early-onset schizophrenia

B.

An organic brain disorder should be ruled out

C.

These are normal findings in very young children

D.

Comprehensive psychiatric assessment is indicated

Question 21

Sarah is a 10-year-old patient who has been diagnosed with
oppositional defiant disorder. While discussing the diagnosis, course and
prognosis, and treatment strategies with Sarah’s mother, the PMHNP emphasizes
that successful management of oppositional defiant disorder (ODD) must include:

A.

Parent training

B.

Pharmacotherapy

C.

Time out

D.

Conflict avoidance

Question 22

Harmony is a 4-year-old female who has been through several
evaluations for behavioral abnormalities that have become increasingly
disruptive, and the family is concerned for the safety of both Harmony and her
2-year-old brother. Comprehensive assessment of Harmony includes
neuropsychiatric testing. The PMHNP documents the presence of neurological hard
signs. These suggest:

A.

Brain lesions

B.

Early-onset schizophrenia

C.

Low intelligence

D.

Learning disability

Question 23

Despite a wealth of data-based information on bullying,
including information about its forms, presenting symptoms, and consequences,
current research suggests that accurate information about bullying is not
influencing preventive and awareness strategies in most school systems. When
advising school personnel, parents, and primary care providers

about bullying, the PMHNP should emphasize that:

A.

Physical bullying has the most dangerous outcomes

B.

Bullying is more common in boys than girls

C.

Victims often develop alcohol abuse problems

D.

Verbal bullying is the most common form

Question 24

Wendy is a 6-year-old female being evaluated by the PMHNP
following a suicide attempt. The police were called when a neighbor saw Wendy
jump out of the open window of her first-floor apartment. She was unhurt, but
when the neighbor asked why she jumped out she said she wanted to kill herself.
Which coincident finding would warrant an inpatient psychiatric admission for
Wendy?

A.

This was not the first episode.

B.

The caretaker is incapable of arranging follow-up.

C.

One or both of the biological parents has a history of
suicide attempts.

D.

Wendy was left with a babysitter when the incident occurred.

Question 25

Psychiatric assessment of the adolescent patient is
different in several ways from assessment of younger children. While trying to
establish a therapeutic environment with an adolescent who is openly hostile,
one of the most important things the PMHNP can do is to:

A.

Be more liberal in terms of limit setting and tolerating
hostility in order to facilitate honest communication

B.

Ensure the patient that under no circumstances will anything
said be repeated to the parents

C.

Allow silences to last as long as necessary until the
patient is inclined to offer any verbal input

D.

Communicate to the patient that his or her perspective is
valued and will not be judged or critiqued

Question 26

The PMHNP is preparing an educational program for primary
care providers about child abuse awareness. The goal of the program is to
increase the understanding of primary care providers regarding risk factors for
child abuse so that at-risk families may be identified and primary preventive
strategies implemented before any harm occurs to children. The program
emphasizes risk factors for child maltreatment to include all of the following
except:

A.

Single-parent families

B.

Low parental education

C.

Parental substance abuse

D.

Firstborn child in the family

Question 27

A variety of questionnaires, scales, guided-interview tools,
and other standardized instruments are available to aid with various aspects of
assessment. The majority are intended only to be used as an aid to information
gathering and not to make a diagnosis. Which of the following tools requires
training to administer and can be used to determine diagnoses?

A.

Child and Adolescent Psychiatric Assessment (CAPA)

B.

Brief Impairment Scale

C.

Pictorial Instrument for Children and Adolescents
(PICA-III-R)

D.

Achenbach Child Behavior Checklist

Question 28

Brian is a 13-year-old boy who presents for care. He was
initially brought in by his mother after a family friend suggested mental
health evaluation. Brian has been suffering with a variety physical symptoms
for the past 8 months, ever since school started. He has missed so much school
that he is in danger of not advancing to the eighth grade. He persistently
complains of headache, stomachache, nausea, and dizziness. He has even vomited
on more than one occasion, so his mother knows something is ?really wrong.? The
pediatrician has been unable to identify a cause of symptoms or offer any
relief. During his interview, the PMHNP learns that this is Brian’s first year
in middle school. There are hundreds of students, and it is much larger than
the intimate elementary school Brian attended from kindergarten through sixth
grade. Brian is certain that all the students are making fun of him; he does
not even go to the lunchroom to eat. He has stopped socializing with his small
group of friends from elementary school because they have made friends among
the other seventh graders. Brian says he wants to have friends, but he just
gets nervous and he is sure they will all make fun of him. Brian enjoys
?hanging out? with his cousins, and they spent the week of spring break playing
at his house. But, when it was time to go back to school, Brian was so nauseous
he could not attend. Initial treatment for Brian should include:

A.

Psychiatric hospitalization

B.

Cognitive behavioral therapy

C.

Fluvoxamine (Luvox) 50 mg daily

D.

Family interventions

Question 29

When evaluating treatment strategies for a 14-year-old
patient with obsessive-compulsive disorder (OCD), the PMHNP considers that
evidence-based data from the Pediatric OCD Treatment Study (POTS) suggests that
best outcomes are achieved with cognitive behavioral therapy (CBT) and:

A.

Clomipramine (Anafranil)

B.

Sertraline (Zoloft)

C.

Aripiprazole (Abilify)

D.

Lithium (Eskalith)

Question 30

Susan is a 10-year-old girl who has been referred by her
pediatrician for mental health evaluation due to a persistent collection of
somatic symptoms for which there is no apparent organic cause. For the last 2
months Susan has been increasingly distraught at the prospect of leaving home.
This has become very apparent since the start of the school year. She often
develops stomachaches and headaches when it is time to go to school. Lately she
does not want to go to bed unless her mother remains upstairs. The PMHNP
considers a diagnosis of:

A.

Separation anxiety disorder

B.

Social anxiety disorder

C.

Generalized anxiety disorder

D.

Social phobia disorder

Question 31

Nate is a 9-year-old boy who presents for a follow-up visit.
He was diagnosed with ADHD 4 months ago and started on methylphenidate 5 mg
b.i.d. At a 1-month follow-up

his mother reported that he was not really demonstrating any
improvement of symptoms, so he was increased to 10 mg b.i.d. He has been on
this dose for 1 month. Nate reports that sometimes he doesn’t feel so great; he
gets a stomach ache sometimes and a few weeks ago he felt ?dizzy.? His vital
signs are within normal limits. Mom says that on this dose his teacher says his
behavior in school is much improved, and she notices that at home he seems more
focused and is able to do his homework and chores. The appropriate action with
regard to his medications at this point would be to:

Discuss with Mom nonstimulant options such as atomoxetine

Reduce his dose back to 5 mg b.i.d. until adverse effects
resolve

Add 25 mg of diphenhydramine to his daily regimen at h.s.

Continue the current plan of care and reassess in 1 month

Question 32

Management of a child who has a pattern of fire-setting
behavior must include:

A.

Combination therapies that include medication with an SSRI

B.

Parental counseling that the child should never be allowed
home alone

C.

Inpatient admission for intensive individual and group
therapy

D.

Behavioral interventions characterized by negative
reinforcement

Question 33

Which of the following behaviors is least suspicious for an
adolescent who is being bullied at school?

A.

A significant change in study habits in which the patient is
demonstrating higher academic achievement to the exclusion of a social life

B.

A persistent, sustained increase in the number and variety
of physical complaints that have no obvious organic cause

C.

Evidence that the patient has started smoking cigarettes and
seems to spend more time alone than usual

D.

Migration to a completely different peer group and a change
in appearance and behavior to aggressively mimic the new group

Question 34

The PMHNP is evaluating the data he has collected in the
assessment of Anna, a 9-year-old girl who presented for evaluation because her
teacher strongly encouraged Anna’s mother to seek care. According to the
teacher, Anna has been consistently disruptive in the classroom since the
beginning of the school year, 2 months ago. The assessment includes
unstructured interviews with Anna, her mother, and grandmother, and Connors
Parent or Teacher Rating Scale for ADHD completed by her primary school teacher
and mother. The PMNHP notes a marked disparity among reports—they all seem to
contradict each other. The PMHNP considers that this apparent contradiction:

A.

Likely indicates a subjective bias from the mother or
teacher

B.

May accurately reflect Anna’s behavior in different settings

C.

Requires that other adults exposed to Anna’s behavior
provide input

D.

Indicates that a different approach to Anna’s assessment is
necessary

Question 35

Kristina is a 17-year-old female who was encouraged to care
by her parents because they have been worried about her. She has always been
very healthy, happy, and active in school and sports. Her boyfriend of three
years broke up with her last fall, right before he left for college. Since then
she has lost all interest in her friends and school. Her parents say that she
doesn’t do anything after school except go to her room. She has lost 16 pounds
in the last 9 months. During the second session with the PMHNP, Kristina
insists that her parents are overreacting, that she is doing OK in school and
is eating just fine. She says of course she was sad that her boyfriend broke up
with her, but she has gotten over it and moved on. During this session, the
PMNHP appreciates that Kristina’s clothes are clearly too big for her, her eyes
fill up with tears whenever her boyfriend is mentioned, and she does not seem
engaged in the interview. While considering her assessment, the PMHNP
recognizes that:

A.

The absence of a remote history of psychiatric disease makes
a true psychiatric diagnosis unlikely

B.

The PMHNP must prioritize Kristina’s subjective report
versus her parents’ report

C.

A standardized assessment tool such as the Patient Health
Questionnaire (PHQ)-9 will be required for diagnosis

D.

The objective signs evident in Kristina’s examination are
more compelling than her perspective on symptoms

Question 36

Because some children exposed to significant traumatic
events do not develop post-traumatic stress disorder (PTSD), there has been
research interest in neurobiology and assessment of predisposing or risk
factors. Children with PTSD have been noted to have which of the following when
compared to age-matched controls?

A.

Overactive amygdalae

B.

Lower intelligence quotients

C.

Preexisting personality disorders

D.

Fourfold risk when first-degree family member affected

Question 37

Richard is an 11-year-old patient who has been hospitalized
following a suicide attempt in which he mixed a variety of household cleansers
and poisons and swallowed them. He has been medically cleared, and his initial
psychiatric assessment reveals a preadolescent male who made this suicide
attempt because he was so unhappy at school. His family recently moved from
another part of the country and he started a new school. The other children
have been bullying him, and he just decided it would be better to die. He has
no siblings and no friends in this new town. Which additional findings during
this assessment would prompt the PMHNP to suggest a psychiatric admission?

A.

His mother has a history of severe post-partum depression

B.

A finding of mild depression during this examination

C.

Appreciable ambivalence about suicide

D.

Complete absence of any other psychiatric diagnoses

Question 38

During the initial interview with Lorraine, a 13-year-old
girl being evaluated for oppositional defiant disorder (ODD), the PMHNP does
not appreciate any of the behavior that has been reported by Lorraine’s mother
and teachers. Lorraine is found to be well groomed, appropriate in her
interaction, and says she is not sure why she is there. Lorraine says that her
parents and teachers say that she is always arguing and breaking the rules, but
she does not really understand what the problem is. The PMHNP notes that:

A.

He will need to have more information from adults who are
not in frequent contact with Lorraine

B.

This is common, as the symptoms are often only expressed to
adults who know the child well.

C.

ODD is episodic, and it is not unusual to have long
symptom-free periods; a normal interview does not preclude diagnosis

D.

The diagnosis should be reconsidered as it is almost
impossible to have a diagnosis of ODD without the patient’s awareness of
symptoms

Question 39

A variety of diagnostic instruments are available to assist
the PMHNP with comprehensive data collection. Which of the following tools is
considered an ?interviewer-based? tool designed as a guide to clinicians
designed to help clarify answers to questions?

A.

The Children’s Interview for Psychiatric Symptoms (ChIPS)

B.

The Diagnostic Interview for Children and Adolescents (DICA)

C.

The Pictorial Instrument for Children and Adolescents
(PICA-III-R)

D.

The Child and Adolescent Psychiatric Assessment (CAPA)

Question 40

Minor physical anomalies, such as high-arched palate,
low-set ears, and transverse palmar creases, occur in a higher than average distribution
in children with all of the following except:

A.

Learning disabilities

B.

Speech and language disorders

C.

Hyperactivity

D.

Delayed puberty

Question 41

Mrs. Jacobs has accompanied her son to today’s session. Her
son is in psychiatric care because he has developed disciplinary issues and for
the last several months has been challenging authority, truant from school, and
openly defiant of the household rules. Mrs. Jacobs is understandably distraught
and is adamant that her son must be the victim of bullying because yesterday he
came home from school with a black eye and a swollen lip. While this has never
happened before, she believes that bullying is the only explanation for his
behavior at home. While counseling Mrs. Jacobs about bullying, the PMHNP
emphasizes that, by definition, bullying:

A.

At some point will always involve physical aggression

B.

Does not occur unless more than one aggressor participates

C.

Is always unprovoked and intentionally cruel

D.

Rarely results in permanent, irreversible physical harm

Question 42

Kelly is a 13-year-old girl who is being evaluated because
her parents are very concerned about her sudden disinterest in school. She does
not want to go to any social activities and her grades have dropped markedly in
the last several months. When considering bullying as a cause of her behavior
change, the PMHP considers that which type of bullying is more common among
girls?

A.

Verbal

B.

Physical

C.

Relational

D.

Cyber

Question 43

With respect to psychiatric assessment, the PMNHP knows that
in terms of confidentiality:

A.

All information related to a minor may be shared with the
parents without the child’s consent.

B.

Whenever there is a suspicion of neglect or abuse, the
appropriate state agency must be notified.

C.

Every state has laws that emancipate children for issues of
mental health.

D.

All children are entitled to confidentiality unless they are
a danger to themselves or others.

Question 44

The PMHNP is evaluating a 15-year-old male patient who has
been referred by his court-appointed guardian. He has been in foster care for
the last 6 years and maintained a steady pattern of low-level behavior problems
such as skipping school and ignoring curfew. He is not openly defiant and has
always been described as a ?loner.? He just does not follow most rules. During
the mental status examination, the PMHNP notes that his expressions are
sometimes inconsistent with the topic of conversation, and he does not seem to
be able to transition effectively among levels of emotion. This represents an
abnormality in:

A.

Mood

B.

Affect

C.

Thought process and content

D.

Judgment and insight

Question 45

The PMHNP is drafting a proposal for research funding for a
project to offer primary prevention strategies designed to reduce the incidence
of bullying. In