Sentinel U APS Pediatric Mental
Health 1 — 100-Question Exam with
Answers AND Rationales UPDATED
2026 NEW!!
SECTION A: PSYCHIATRIC ASSESSMENT AND
DIAGNOSIS (Questions 1–15)
1. In a pediatric primary care setting, which assessment approach best
distinguishes attention-deficit/hyperactivity disorder (ADHD) from anxiety-
related inattention?
A. Observing the child during structured play and academic tasks
B. Administering a continuous performance test (CPT) alone
C. Gathering symptom reports from multiple settings and informants
D. Initiating a stimulant trial and monitoring response
Answer: C. Gathering symptom reports from multiple settings and informants
Rationale: ADHD and anxiety can both present with inattention, but ADHD
symptoms are typically pervasive and present across settings, while anxiety-related
inattention is often situation-specific. Collecting collateral information from home
and school helps differentiate, as per AAP guidelines -5 .
2. Which pharmacogenetic finding would most alter the prescribing of
aripiprazole in an adolescent with irritability associated with autism spectrum
disorder?
A. CYP2D6 poor metabolizer status
B. CYP3A4 inducer phenotype
C. HLA-B*1502 allele positivity
D. UGT1A1*28 polymorphism
Answer: A. CYP2D6 poor metabolizer status
,Rationale: Aripiprazole is partially metabolized by CYP2D6; poor metabolizers have
higher plasma concentrations, increasing adverse effect risk. Dose adjustment or
alternative agent is indicated. CYP3A4 induction affects metabolism but is less
clinically significant, and HLA-B*1502 is linked to carbamazepine-induced SJS, not
aripiprazole -5 .
3. A school-aged child is experiencing frequent nightmares and avoidance of a
specific location following a motor vehicle accident. Which screening tool is
most appropriate for assessing post-traumatic stress symptoms in this child?
A. Child PTSD Symptom Scale (CPSS)
B. Pediatric Symptom Checklist (PSC)
C. Screen for Child Anxiety Related Emotional Disorders (SCARED)
D. Children's Depression Inventory (CDI)
Answer: A. Child PTSD Symptom Scale (CPSS)
Rationale: The CPSS is a validated tool for assessing PTSD symptoms in children and
adolescents, including re-experiencing, avoidance, and hyperarousal. SCARED is for
anxiety disorders, PSC is a general psychosocial screener, and CDI measures
depression -3 .
4. An adolescent with major depressive disorder is started on fluoxetine. After 2
weeks, they report increased energy but persistent low mood and suicidal
ideation. What is the most appropriate next step?
A. Discontinue fluoxetine immediately and switch to a different SSRI
B. Continue fluoxetine and initiate safety planning with close monitoring
C. Add a second antidepressant to augment the current treatment
D. Hospitalize the patient for inpatient psychiatric care
Answer: B. Continue fluoxetine and initiate safety planning with close
monitoring
Rationale: Increased energy before mood improvement can elevate suicide risk, but
fluoxetine often takes 4–6 weeks for full effect. Continuing with close monitoring and
a safety plan is appropriate if risk is manageable. Immediate switch or augmentation
is premature, and hospitalization is reserved for imminent risk -3 .
,5. Which of the following best distinguishes pediatric bipolar disorder from
severe ADHD with mood lability?
A. Presence of distractibility and hyperactivity
B. Episodic, discrete periods of elevated mood lasting several days
C. Chronic irritability without clear episodes
D. Impaired executive function on neuropsychological testing
Answer: B. Episodic, discrete periods of elevated mood lasting several days
Rationale: Bipolar disorder is defined by distinct episodes of mania or hypomania,
while ADHD mood lability is chronic and non-episodic. Chronic irritability without
episodes is more consistent with disruptive mood dysregulation disorder (DMDD).
Distractibility and executive dysfunction are common to both -3 .
6. Which of the following best describes the role of the advanced practice nurse
in the "withdrawn" case of Mark Kwan, specifically regarding coordination of
care?
A. Prescribe all psychotropic medications and provide individual therapy
B. Conduct a comprehensive assessment, initiate evidence-based interventions, and
collaborate with the interdisciplinary team
C. Refer to psychiatry and disengage after the referral is placed
D. Focus primarily on the family's concerns rather than the child's symptoms
Answer: B. Conduct a comprehensive assessment, initiate evidence-based
interventions, and collaborate with the interdisciplinary team
Rationale: The advanced practice nurse is responsible for comprehensive
assessment, diagnosis, and treatment initiation, while also coordinating with the
child's PCP, school, and therapists. Disengaging after referral fragments care; the
APRN should remain involved in coordination -7 .
7. In an adolescent with new-onset anxiety symptoms, which condition must be
ruled out first?
, A. Hyperthyroidism
B. Substance-induced anxiety
C. Panic disorder
D. Pheochromocytoma
Answer: B. Substance-induced anxiety
Rationale: In an adolescent, new-onset anxiety symptoms must first rule out
substance use (e.g., stimulants, caffeine, cannabis) because it is common and easily
missed. Medical causes like hyperthyroidism or pheochromocytoma are important
but less common. Panic disorder is a diagnosis of exclusion after medical/substance
causes are ruled out -7 .
8. Which of the following represents the most critical ethical consideration
when treating a minor for a mental health condition when the parents disagree
about treatment?
A. The clinician must always follow the father's wishes as the legal guardian
B. The clinician should prioritize the child's best interest and safety, potentially
seeking mediation or legal guidance
C. The clinician must obtain consent from both parents before initiating any
treatment
D. The clinician should defer treatment until the parents reach a mutual agreement
Answer: B. The clinician should prioritize the child's best interest and safety,
potentially seeking mediation or legal guidance
Rationale: When parental disagreement arises, the child's best interest is paramount.
Treatment should not be unduly delayed if one parent's refusal is not in the child's
best interest. In many states, consent from one legal guardian is sufficient for
treatment -7 .
9. A 14-year-old presents with declining grades, social withdrawal, and
irritability. Which assessment approach should the NP prioritize first?
A. Order a comprehensive metabolic panel and thyroid function tests
B. Conduct a private interview with the adolescent using HEADSS framework
C. Refer immediately to psychiatry for medication evaluation
D. Administer the Children's Depression Inventory
Health 1 — 100-Question Exam with
Answers AND Rationales UPDATED
2026 NEW!!
SECTION A: PSYCHIATRIC ASSESSMENT AND
DIAGNOSIS (Questions 1–15)
1. In a pediatric primary care setting, which assessment approach best
distinguishes attention-deficit/hyperactivity disorder (ADHD) from anxiety-
related inattention?
A. Observing the child during structured play and academic tasks
B. Administering a continuous performance test (CPT) alone
C. Gathering symptom reports from multiple settings and informants
D. Initiating a stimulant trial and monitoring response
Answer: C. Gathering symptom reports from multiple settings and informants
Rationale: ADHD and anxiety can both present with inattention, but ADHD
symptoms are typically pervasive and present across settings, while anxiety-related
inattention is often situation-specific. Collecting collateral information from home
and school helps differentiate, as per AAP guidelines -5 .
2. Which pharmacogenetic finding would most alter the prescribing of
aripiprazole in an adolescent with irritability associated with autism spectrum
disorder?
A. CYP2D6 poor metabolizer status
B. CYP3A4 inducer phenotype
C. HLA-B*1502 allele positivity
D. UGT1A1*28 polymorphism
Answer: A. CYP2D6 poor metabolizer status
,Rationale: Aripiprazole is partially metabolized by CYP2D6; poor metabolizers have
higher plasma concentrations, increasing adverse effect risk. Dose adjustment or
alternative agent is indicated. CYP3A4 induction affects metabolism but is less
clinically significant, and HLA-B*1502 is linked to carbamazepine-induced SJS, not
aripiprazole -5 .
3. A school-aged child is experiencing frequent nightmares and avoidance of a
specific location following a motor vehicle accident. Which screening tool is
most appropriate for assessing post-traumatic stress symptoms in this child?
A. Child PTSD Symptom Scale (CPSS)
B. Pediatric Symptom Checklist (PSC)
C. Screen for Child Anxiety Related Emotional Disorders (SCARED)
D. Children's Depression Inventory (CDI)
Answer: A. Child PTSD Symptom Scale (CPSS)
Rationale: The CPSS is a validated tool for assessing PTSD symptoms in children and
adolescents, including re-experiencing, avoidance, and hyperarousal. SCARED is for
anxiety disorders, PSC is a general psychosocial screener, and CDI measures
depression -3 .
4. An adolescent with major depressive disorder is started on fluoxetine. After 2
weeks, they report increased energy but persistent low mood and suicidal
ideation. What is the most appropriate next step?
A. Discontinue fluoxetine immediately and switch to a different SSRI
B. Continue fluoxetine and initiate safety planning with close monitoring
C. Add a second antidepressant to augment the current treatment
D. Hospitalize the patient for inpatient psychiatric care
Answer: B. Continue fluoxetine and initiate safety planning with close
monitoring
Rationale: Increased energy before mood improvement can elevate suicide risk, but
fluoxetine often takes 4–6 weeks for full effect. Continuing with close monitoring and
a safety plan is appropriate if risk is manageable. Immediate switch or augmentation
is premature, and hospitalization is reserved for imminent risk -3 .
,5. Which of the following best distinguishes pediatric bipolar disorder from
severe ADHD with mood lability?
A. Presence of distractibility and hyperactivity
B. Episodic, discrete periods of elevated mood lasting several days
C. Chronic irritability without clear episodes
D. Impaired executive function on neuropsychological testing
Answer: B. Episodic, discrete periods of elevated mood lasting several days
Rationale: Bipolar disorder is defined by distinct episodes of mania or hypomania,
while ADHD mood lability is chronic and non-episodic. Chronic irritability without
episodes is more consistent with disruptive mood dysregulation disorder (DMDD).
Distractibility and executive dysfunction are common to both -3 .
6. Which of the following best describes the role of the advanced practice nurse
in the "withdrawn" case of Mark Kwan, specifically regarding coordination of
care?
A. Prescribe all psychotropic medications and provide individual therapy
B. Conduct a comprehensive assessment, initiate evidence-based interventions, and
collaborate with the interdisciplinary team
C. Refer to psychiatry and disengage after the referral is placed
D. Focus primarily on the family's concerns rather than the child's symptoms
Answer: B. Conduct a comprehensive assessment, initiate evidence-based
interventions, and collaborate with the interdisciplinary team
Rationale: The advanced practice nurse is responsible for comprehensive
assessment, diagnosis, and treatment initiation, while also coordinating with the
child's PCP, school, and therapists. Disengaging after referral fragments care; the
APRN should remain involved in coordination -7 .
7. In an adolescent with new-onset anxiety symptoms, which condition must be
ruled out first?
, A. Hyperthyroidism
B. Substance-induced anxiety
C. Panic disorder
D. Pheochromocytoma
Answer: B. Substance-induced anxiety
Rationale: In an adolescent, new-onset anxiety symptoms must first rule out
substance use (e.g., stimulants, caffeine, cannabis) because it is common and easily
missed. Medical causes like hyperthyroidism or pheochromocytoma are important
but less common. Panic disorder is a diagnosis of exclusion after medical/substance
causes are ruled out -7 .
8. Which of the following represents the most critical ethical consideration
when treating a minor for a mental health condition when the parents disagree
about treatment?
A. The clinician must always follow the father's wishes as the legal guardian
B. The clinician should prioritize the child's best interest and safety, potentially
seeking mediation or legal guidance
C. The clinician must obtain consent from both parents before initiating any
treatment
D. The clinician should defer treatment until the parents reach a mutual agreement
Answer: B. The clinician should prioritize the child's best interest and safety,
potentially seeking mediation or legal guidance
Rationale: When parental disagreement arises, the child's best interest is paramount.
Treatment should not be unduly delayed if one parent's refusal is not in the child's
best interest. In many states, consent from one legal guardian is sufficient for
treatment -7 .
9. A 14-year-old presents with declining grades, social withdrawal, and
irritability. Which assessment approach should the NP prioritize first?
A. Order a comprehensive metabolic panel and thyroid function tests
B. Conduct a private interview with the adolescent using HEADSS framework
C. Refer immediately to psychiatry for medication evaluation
D. Administer the Children's Depression Inventory
