NR 606 WEEK 8 FINAL EXAM 2025/2026 COMPLETE QUESTIONS AND 100% CORRECT ANSWERS WITH RATIONALE

NR 606 WEEK 8 FINAL EXAM 2025/2026 COMPLETE QUESTIONS AND 100% CORRECT ANSWERS WITH RATIONALE “Steps for Obtaining Informed Consent - CORRECT ANSWER -Assess pt ability to understand medical info, tx options, to make a voluntary decision. -Present relevant info with accuracy and sensitivity: • diagnosis • nature & purpose of tx options • benefits, risks, burdens of all tx options, including forgoing tx -Document informed consent conversation in the medical record, including all consent forms." "Underlying assumptions for child and adolescent psychotherapy - CORRECT ANSWER Developmental considerations Family involvement Systems involvement Resiliency" "Medication-Assisted Treatment (MAT) - CORRECT ANSWER Treatment for opioid use disorder combining the use of medications (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies." "Mental health and youth - CORRECT ANSWER -13% of children ages 8-15 experience a mental health condition -50% of children ages 8-15 experiencing a mental health condition do not receive tx -13-20% of children living in the U.S. (1 out of 5 children) experience a mental health condition in a given year -17% of high school students seriously consider suicide -1/2 of all lifetime cases of mental illness begin by age 14" "Barriers to Mental Health Treatment in Children and Adolescents - CORRECT ANSWER -lack of sufficient information or access to services -stigmas or negative perceptions towards mental health services -many drop out before receiving effective treatment, often due to: • poverty • language barriers • living in communities with scarce resources • stressors such as problems in the family violence in the community unstable housing unemployment food insecurity -Cost -scheduling conflicts -long waitlists for services -high staff turnover" "Prescribing Considerations for Children and Adolescents - CORRECT ANSWER -physiologic factors impact pediatric med selection & dosing -Children, more rapid metabolism than adults, may require larger dose of med per unit of body weight -Around puberty, pharmacokinetic properties reach adult parameters • dosing after puberty may need to be decreased -Developmental considerations • attuned to signs of adverse effects, younger children may not be able to communicate complaints" "Ethical Considerations in the Treatment of Children and Adolescents: Mandatory Reporting - CORRECT ANSWER -PMHNPs mandated reporters in most states • required to report suspicions about abuse or neglect to the appropriate authorities -federal & state statutes include stipulations related to mandatory reporting -PMHNPs responsible for following all relevant statutes in their state of practice" "most common complication during the perinatal period? - CORRECT ANSWER Mental health problems" "maternal mental health - CORRECT ANSWER -Up to 1 in 5 women will suffer from a maternal mental health disorder like postpartum depression -15% of women receive tx -1 in 7 will experience depression during pregnancy -Up to 50% of women living in poverty will suffer from a maternal mental health disorder -Maternal mental health disorders impact the whole family, not just moms -More than 600,000 women will suffer from a maternal mental health disorder in the U.S. ever year -Anxiety & depression have risen 37% in teen girls. This will increase the number of women suffering postpartum depression in the future -Rates of depression are more than doubled in Black moms due to cumulative effects of stress called weathering" "Ethical Considerations in Maternal Mental Health Tx - CORRECT ANSWER -PMHNP must carefully weigh the risks & benefits r/t starting, continuing, switching, or discontinuing med therapy during the perinatal period -work to create tx plans that respect clients' goals & perspectives" "Discontinuation of medications for pregnancy is associated with a relapse rate of ___________% for clients who take mood stabilizers - CORRECT ANSWER 80-100%" "Informed consent: pregnancy - CORRECT ANSWER -must initiate discussion with pt regarding informed consent for tx • whether new symptoms during pregnancy or already established with care • risks of continuing current meds and the risks of stopping them -help pt process their risk factors & tx hx to make an informed decision -if must remain on high-risk medications such as valproic acid should be thoroughly evaluated by the multidisciplinary team including a perinatal psychiatrist -Documentation should note whether the woman plans to continue with treatment or discontinue the medication" "Kenya is a 36-year-old who has been taking fluoxetine for three years for major depressive disorder. Her symptoms are currently in remission, and she just found out that she is 7 weeks pregnant. She calls the PMHNP to discuss whether she should continue her medication during pregnancy. After the discussion, Kenya indicates that she will remain on her medication. Which of the following should be included in the discussion and documentation of the call with Kenya? Select all that apply. rare adve - CORRECT ANSWER rare adverse effect of persistent pulmonary hypertension in the neonate common adverse effect of postnatal abstinence syndrome potential risks of discontinuing treatment to both mother and baby decision to continue treatment Rationale: The PMHNP should disclose all common adverse effects and discuss serious adverse effects associated with the medication, regardless of incidence. The discussion should include the potential risks to both mother and baby if the medication is discontinued. Documentation should include the client's decision whether to continue or discontinue treatment. Since fluoxetine is not a high-risk medication for pregnancy, the PMHNP need not refer the client to a perinatal psychiatrist for medication management." "Pregnancy Safety Considerations for Common Mental Health Treatment: Meds for Depression & Anxiety - CORRECT ANSWER -SSRIs are first-line treatments for depression and anxiety during pregnancy -SNRIs, tricyclic's, & bupropion are also considered safe tx options -most common adverse effect with SSRIs & SNRIs is neonatal withdrawal syndrome • Symptoms: tremors, high-pitched crying, disturbed sleep (peaks 2-4 days after birth) • impacts up to 30% of babies born to mothers who take antidepressant medication • no evidence D/Cing or tapering dosages in last trimester reduces risk to infant -Paroxetine may increase risk of atrial septal defects -Benzodiazepines taken with caution for anxiety • risk of newborn toxicity must be considered and monitored if used • Symptoms: sedation, floppy muscle tone, potential breathing issues at birth" "Pregnancy Safety Considerations for Common Mental Health Treatment: Meds for Bipolar Disorder - CORRECT ANSWER -Lamotrigine considered safe during pregnancy • may not be effective for manic episodes -Lithium exposure during first trimester has small but significant risk of cardiac malformations • increases with higher doses • risks and benefits carefully considered, Consider the gestational age of the embryo and fetus -AVOID DURING PREGNANCY • valproic acid and carbamazepine are considered teratogenic" "Pregnancy Safety Considerations for Common Mental Health Treatment: Meds for Psychosis - CORRECT ANSWER -atypical antipsychotic medications, particularly olanzapine and quetiapine • increased risk of gestational diabetes D/Cing may not decrease the risk • increased risk of large for gestational age infants -Olanzapine increase the risk of musculoskeletal malformations in infants -Risperidone & quetiapine are the most used antipsychotics during pregnancy • Neither cause malformations -Antipsychotic meds may cause neonatal withdrawal symptoms • close monitoring of newborn several days after delivery" "Johnita has been taking sertraline 100 mg daily for 4 years for major depressive disorder. Her symptoms have fluctuated over the past year. She is 10 weeks pregnant. Which of the following is the most appropriate recommendation for Johnita? continue sertraline 100 mg daily decrease sertraline to 50 mg daily increase sertraline to 150 mg daily discontinue sertraline - CORRECT ANSWER continue sertraline 100 mg daily Rationale: Sertraline is considered a safe medication during pregnancy. The client's symptoms have fluctuated on her current medication dose; therefore, decreasing the dose may cause a relapse of symptoms." "Health Risks Associated with SUDs: Tobacco - CORRECT ANSWER No tobacco product is considered safe for use during the perinatal period -Smoking-related pregnancy complications: • ectopic pregnancy • placental abruption • placenta previa • fetal mortality • stillbirth • preterm birth • low birth weight infants -Smoking-related effects on neonates: • sudden infant death syndrome • birth malformations oral clefts neural tube defects -Smoking-related effects on infants, children, and adolescents: • asthma • cognitive impairment • lower respiratory illness • ADHD • central nervous system tumors" "Health Risks Associated with SUDs: Alcohol - CORRECT ANSWER -Drinking while pregnant costs the US $5.5 billion -CDC: no safe time to drink during pregnancy, no safe quantity of alcohol to consume while pregnant or trying to get pregnant -1st trimester exposure correlates with the most significant alcohol-related birth outcomes -increased risk for miscarriage, stillbirth, congenital anomalies, low birth weight, small for gestational age, and preterm delivery -Lifelong effects of AUD on children: • fetal alcohol spectrum disorders (FASDs) • neurodevelopmental & CNS deficits • speech & language challenges • cognitive & behavioral deficits • impaired executive functioning • psychosocial difficulties in adulthood" "fetal alcohol spectrum disorders (FASDs) - CORRECT ANSWER Up to 1 in 20 US school children may have FASDs -Physical Issues: • low birth weight and growth. • problems with heart, kidneys, and other organs. • damage to parts of the brain. Leads to... -Behavioral and intellectual disabilities: • learning disabilities and low IQ • hyperactivity • difficulty with attention • poor ability to communicate in social situations • poor reasoning and judgment skills Can lead to... -Lifelong issues with: • school and social skills • living independently • mental health • substance use • keeping a job • trouble with the law" "Health Risks Associated with SUDs: Cannabis - CORRECT ANSWER -often combined with other substances -associated with: • preterm labor • low birth weight • small for gestational age deliveries • adverse effects on fetal and adolescent brain growth • adverse effects on executive functioning skills • behavioral problems • adverse effects on academic achievement -All forms of cannabis have adverse effects, even medical marijuana" "A stereotypic belief that individuals choose to use alcohol or other drugs and blame them for their substance use disorder is an example of _________ stigma - CORRECT ANSWER public" "Madden (2019) has proposed a new category of stigma: intervention stigma - CORRECT ANSWER -"Individuals working in [medication-assisted treatment] MAT experience discrimination and prejudice from other healthcare professionals -discrimination & prejudice stem at times from stigma toward addiction diagnoses" "Structural Stigma in U.S. Drug Policies - CORRECT ANSWER -nation's drug policies tend to follow 1 of 2 diff. aims: • offering medical care such as MAT • criminalizing behaviors associated with substance use -Fear of legal repercussions and the involvement of children's services may lead women to avoid reporting substance use • # of states with punitive policies/requirements for providers to report suspected prenatal drug use has more than doubled in the last decade, resulting in poor health outcomes" "State Policy on Substance Use During Pregnancy - CORRECT ANSWER -authorizing civil commitment -criminalizing the behavior as child abuse or neglect -requiring providers to notify child protective services when an infant is affected by illegal substance abuse -requiring providers to report or test for prenatal drug exposure, which is permissible evidence in child-welfare proceedings" "In 2023, the Guttmacher Institute reported: - CORRECT ANSWER -24 states and the District of Columbia consider prenatal substance use to be child abuse -3 states and the District of Columbia consider it grounds for civil commitment -25 states and the District of Columbia mandate provider reporting of suspected prenatal drug use -8 states require providers to test for prenatal drug exposure if drug use is suspected -19 states have created or funded drug treatment programs specifically for pregnant people -10 states prohibit publicly funded drug treatment programs from discriminating against pregnant people" "Of pregnant women who were anonymously tested for drug use, the prevalence of use was found to be similar between Black and White women, but Black women were _____ times more likely to be reported to law enforcement. - CORRECT ANSWER 10x" "_______________ women suffer from higher SUD rates compared to other racial and ethnic groups and are disproportionately affected by criminalization laws at the federal, state, and tribal levels. - CORRECT ANSWER Indigenous" "Consistent use of medication for OUD treatment during pregnancy is significantly lower for ________________________. - CORRECT ANSWER women of color" "substance use during pregnancy Assessment and Screening - CORRECT ANSWER -The U.S. Preventative Services Task Force (USPSTF) and ACOG have recommended the Brief Intervention and Referral to Treatment (SBIRT) approach • screen for substance use during the perinatal period -Validated screening tools for substance use during pregnancy • Substance Use Risk Profile-Pregnancy scale (SURP-P) • 4P's Plus can also include validated screening questions for depression & domestic violence" "prefrontal cortex controls: - CORRECT ANSWER attention, memory, mood, & personality" "MDD - CORRECT ANSWER -primary feature of MDD is the occurrence of at least 1 episode of major depression lasting at least 2 weeks -must experience 5 or more of the following symptoms in 2 weeks to be diagnosed with a major depressive episode: • feeling low most of the day for most days • decreased interest in activities • substantial weight loss, significant change in appetite • fidgeting, random movement (i.e. pacing) • decreased energy • sense of guilt or worthlessness • lack of focus or ability to make decisions • repeated thoughts of death and suicide" "Depression meds - CORRECT ANSWER -SSRIs -SNRIs -TCAs -MAOIs" "Selective Serotonin Reuptake Inhibitors (SSRIs) - CORRECT ANSWER -Action: • inhibits the reuptake of serotonin -Ex: • citalopram • escitalopram • fluoxetine • paroxetine • sertraline -Common Side Effects: • nausea, agitation, headache, and sexual dysfunction" "Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) - CORRECT ANSWER -Action: • inhibits the reuptake of serotonin and norepinephrine -Ex: • desvenlafaxine • duloxetine • levomilnacipran • venlafaxine -Common Side Effects: • nausea, sweating, insomnia, tremors, sexual dysfunction" "Tricyclic Antidepressants (TCAs) - CORRECT ANSWER -Action: • inhibits the reuptake of serotonin & norepinephrine • blocks norepinephrine, histamine, & acetylcholine receptors -Ex: • amitriptyline • clomipramine • desipramine • doxepin -Common Side Effects: • dry mouth, constipation, blurred vision, urinary retention sedation, weight gain, hypotension, tachycardia, and sexual dysfunction" "Monoamine Oxidase Inhibitors (MAOIs) - CORRECT ANSWER -Action: • increases norepinephrine & serotonin by inhibiting the enzyme that inactivates it -Ex: • isocarboxazid • phenelzine • tranylcypromine -Common Side Effects: • sedation, dizziness, sexual dysfunction, & hypertensive crisis" "Select the lab tests required for Lithium: thyroid function liver function tests (LFTs) renal function hemoglobin A1C (HbA1C) complete blood count (CBC) serum lithium level - CORRECT ANSWER thyroid function serum lithium level renal function Rationale: Lithium has a narrow therapeutic index and should be monitored carefully. Serum levels should be evaluated 5 days after any dosage change and regularly at 6-month intervals. Lithium can cause renal and thyroid toxicity. Renal and thyroid function should be evaluated every 6 months." "consequences of untreated MMHDs: Impact on the Mother - CORRECT ANSWER • Have poor nutrition • Use substances such as alcohol, tobacco, or drugs • Experience physical, emotional, or sexual abuse • Be less responsive to baby's cues • Have fewer positive interactions with baby • Experience breastfeeding challenges • Question their competence as mothers" "consequences of untreated MMHDs: Impact on the Child - CORRECT ANSWER • Low birth weight or small head size • Pre-term birth • Longer stay in the NICU • Excessive crying • Impaired parent-child interactions • Social-emotional, cognitive, language, motor, & adaptive behavior development • Untreated mental health issues in the home may result in an Adverse Childhood Experience, which can impact the long-term health of the child." "terms used to refer to the conditions women experience during pregnancy and the first postpartum year: - CORRECT ANSWER -postpartum depression (PPD) -perinatal (or antenatal, prenatal, or postpartum) depression & anxiety -perinatal mood disorders (PMDs) or perinatal mood & anxiety disorders (PMADs) -maternal mental health disorders" "Barriers to Maternal Mental Health Care - CORRECT ANSWER -inconsistencies in terminology can lead to mistreatment in maternity care -classification of maternal mental health disorders in the (DSM-5-TR) • depressive disorder specifier "with peripartum onset" timeframe for using the specifier remains confined to the first four weeks after birth" "Risk Factors for MMHDs - CORRECT ANSWER -Smoking -Lack of social support -Poor relationship quality -Pregnancy complications -Personal or family history of depression -History of physical or sexual abuse -Unintended pregnancy -Life stress -Chronic physical conditions -Prior pregnancy with fetal/infant loss -History of mental illness -Social Determinants of Health • low monthly income, lower education levels, or unemployed status, childbearing people who are unpartnered" "Reasons for post-adoption depression: - CORRECT ANSWER -unrealistic expectations -difficulties bonding with the infant or child -complicated relationships with birthparents in open adoptions -underestimation of the impact that adoption would have on parents' and families' lives -question their legitimacy as a parent" "MMHDs: Bipolar Disorder - CORRECT ANSWER -DSM-5-TR includes a specifier for bipolar disorder with peripartum onset • symptoms that begin during pregnancy or in the first four weeks following childbirth -childbirth can trigger hypomanic episodes • often early in the postpartum period • may have severe depressive episode several weeks later -Early detection of signs of hypomania is necessary to reduce suicide & infanticide risk" "MMHDs: Anxiety Disorder - CORRECT ANSWER -Generalized anxiety disorder • difficult to distinguish from symptoms experienced by new parents -Symptoms: irritability, difficulty sleeping, difficulty concentrating, easy fatiguability -Themes of worry: • pregnancy and delivery complications • infant well-being • maternal or partner illness -Risk factors: prior hx of ax" "MMHDs: Psychosis - CORRECT ANSWER -DSM-5-TR: "brief psychotic disorder with peripartum onset" when symptoms present suddenly during pregnancy or within the first 4 weeks after birth & last at least one day but no more than one month -preexisting bipolar disorder have highest risk -Loss of sleep is common precipitating factor -presents with at least 1 of the following symptoms: • delusions • hallucinations • disorganized speech • grossly disorganized or catatonic behavior -Suicide and infanticide are primary concerns -Hallucinations or delusions r/t the infant are common -considered a psychiatric emergency & requires immediate hospitalization and tx" "__________________ is considered a psychiatric emergency and requires immediate hospitalization and treatment - CORRECT ANSWER Perinatal psychosis" "MMHDs: OCD - CORRECT ANSWER -Pregnancy creates risk for onset or exacerbation of OCD -peripartum period, approximately 1.5-2x more likely to experience OCD compared to general pop. -47% of women with OCD experience first onset during peripartum period -Common obsessions: • fears of contaminating the baby • need for exactness • thoughts of aggression towards infant fear being left alone with infant, may distance self from infant to avoid acting on the thoughts • fears of infant death -common compulsions: • repetitive handwashing • checking the infant" "MMHDs: PTSD - CORRECT ANSWER -1-5% experience PTSD during the perinatal period -Risk factors: • previous trauma • hx of sexual abuse • complications with past pregnancies • traumatic births or labor experiences • instrument-assisted vaginal births or cesarean sections • peripartum depression • previous mental illness" "maternal mental health disorders: Screening - CORRECT ANSWER -recommendations from the American College of Obstetricians and Gynecologists (ACOG) • screening at least once during the perinatal period using a validated instrument • increasing the frequency of visits when symptoms are identified • referring clients for appropriate pharmacotherapy & psychotherapy treatments -American Academy of Pediatrics (AAP) recommends: • incorporating the Edinburgh Postnatal Depression Scale (EPDS) into infants' 1, 2, 4, and 6-month well check visits using a cutoff score of 10 as an indicator that maternal depression may be present" "Edinburgh Postnatal Depression Scale (EPDS) to screen for maternal mental health disorders - CORRECT ANSWER -questionnaire to identify women who may have postpartum depression -A score of more than 10 suggests minor or major depression may be present • Further evaluation is recommended "Shawnta is a 29-year-old who delivered her first child one month ago. She has been seeing a psychiatric mental health nurse practitioner for therapy for the past two years to work on post-traumatic stress disorder following a sexual assault. She has no other psychiatric or physical health history and no family history of mental illness. Shawnta presents for a telehealth therapy visit and notes that over the past few days, she has felt more "down" than usual. Her partner returned to work a we - CORRECT ANSWER plan to repeat the screening in two weeks at Shawnta's next therapy appointment Rationale: Mothers who score over 13 on the EPDS are likely suffering from depressive illness; however, the EPDS only indicates how the client felt during the previous week. Therefore, a follow-up assessment in two weeks is indicated." "At Shawnta's next appointment two weeks later, she endorses increased feelings of sadness and worry, mostly surrounding the baby. Her repeat EPDS screening score is 14. Which of the following management strategies is the most appropriate next course of action for Shawnta? plan to repeat the screening in two weeks at Shawnta's next therapy appointment request that Shawnta schedule an in-person visit as soon as possible request a joint therapy session with Shawnta's partner discuss antid - CORRECT ANSWER discuss antidepressant medications Rationale: Shawnta's current EPDS score of 14 indicates likely depressive disorder, which requires the PMHNP to discuss treatment options with her, which may include antidepressant medications." "treating MMHDs: Perinatal Depression - CORRECT ANSWER -SSRIs: first-line pharmacologic once bipolar II disorder ruled out -tricyclic antidepressants -omega-3 fatty acids may reduce depressive symptoms -brexanolone: • new tx for postpartum depression • IV infusion over 60 hours at certified healthcare facility • must be enrolled in the Risk Evaluation & Mitigation Strategy Program -Nonpharmacologic: • CBT • interpersonal therapy • electroconvulsive therapy for severe" "treating MMHDs: Perinatal Bipolar Disorder - CORRECT ANSWER -Pharmacologic: • lithium • lamotrigine -Nonpharmacologic: • CBT • interpersonal therapy • behavioral therapy • social rhythm therapy" "treating MMHDs: Perinatal Anxiety - CORRECT ANSWER -Pharmacologic: • SSRIs -Nonpharmacologic: • CBT • interpersonal therapy" "treating MMHDs: Perinatal Psychosis - CORRECT ANSWER -Pharmacologic: • mood stabilizers • antipsychotics • antidepressants • benzodiazepines -Nonpharmacologic: • inpatient hospitalization • electroconvulsive therapy" "treating MMHDs: Perinatal OCD - CORRECT ANSWER -Pharmacologic: • SSRIs -Nonpharmacologic: • CBT with psychoeducation, cognitive restructuring, and exposure with response prevention" "treating MMHDs: Perinatal PTSD - CORRECT ANSWER -Pharmacologic: • psychotherapy is typically used as first-line • SSRIs may be used for comorbid depression -Nonpharmacologic: • expressive writing • eye movement desensitization and reprocessing (EMDR) • CBT" "Maternal Mental Health, Epigenetics, and Child Health: Lifespan Considerations - CORRECT ANSWER -Maternal depression & anxiety can impact: • fetal development in utero • increase risk for preterm birth & low birth weight • lead to an insecure attachment between mother & infant • suboptimal breastfeeding practices • long-term effects: decreased social-emotional, cognitive, language, motor, & adaptive behavior developmental outcomes -PTSD following trauma exposure in childbearing people • lasting detrimental impact on child health" "How a caregiver's trauma can impact a child's development: Early development - CORRECT ANSWER -Mother releases cortisol • Baby absorbs cortisol through placenta Can impact baby's: HPA axis, CNS, Limbic system, ANS -Caregiver struggles to regulate -Attachment relationship strained • Can impact child's: Development of a core sense of self Ability to integrate experiences Epigenetic expressions" "How a caregiver's trauma can impact a child's development: Adulthood - CORRECT ANSWER -person who had a caregiver with untreated trauma may: • Be more prone to PTSD after trauma • Struggle to repair after conflict • Struggle with relationships • Unintentionally bring out negative behaviors in others • Be emotionally detached • Be more prone to dissociate" "Stigma of Maternal Mental Health Disorders - CORRECT ANSWER -may impact the individual's sense of safety regarding sharing their negative or challenging experiences • may fear revealing symptoms to others out of shame, guilt, or fear that their infant may be taken away from them" "___________ and ___________ have been demonstrated to have the lowest serum concentrations among infants exposed to medication during breastfeeding - CORRECT ANSWER Bupropion and Sertraline" "Pediatric Anxiety & Obsessive-Compulsive Disorder (OCD) - CORRECT ANSWER -Separation anxiety -Social anxiety -OCD -Body dysmorphic disorder" "Anxiety - CORRECT ANSWER -Increased brain activity in the amygdala & prefrontal cortex -PET scans have also shown reduced serotonin binding in patients with anxiety -GAD • persistent, uncontrollable worrying that causes emotional distress, symptoms on most days, for a period of at least 6 months -Symptoms: • worrying, restlessness, irritability, muscle tension, fatigue, sleep disturbances" "Risk factors for developing anxiety - CORRECT ANSWER -genetic predisposition (family history of anxiety) -being female -recent life stressors -chronic physical illness -lack of support during childhood" "Medications for anxiety: GAD - CORRECT ANSWER -SSRIs -SNRIs -buspirone -Drug Therapy at least 12 months" "Medications for anxiety: Panic Disorder - CORRECT ANSWER -paroxetine -sertraline -fluoxetine -Drug therapy 6-9 months" "Medications for anxiety: OCD - CORRECT ANSWER -fluoxetine -fluvoxamine -sertraline -paroxetine -clomipramine (TCA) -Drug therapy for at least 1 year" "Medications for anxiety: Social Anxiety Disorder - CORRECT ANSWER -sertraline -paroxetine -Drug therapy takes 4 weeks to see effects" "Medications for anxiety: PTSD - CORRECT ANSWER -paroxetine -sertraline" "Depression - CORRECT ANSWER -Decreased brain activity in the prefrontal cortex -symptoms that last 2 weeks -Symptoms: • depressed or irritable mood, diminished interest in activities, significant weight or appetite changes, fatigue, feelings of worthlessness, sleep disturbances, diminished ability to concentrate -can be influenced by genetic & environmental factors, stressful life events • giving birth or experiencing emotional trauma -linked to neurotransmitter imbalances" "MDD - CORRECT ANSWER -primary feature of MDD is the occurrence of at least 1 episode of major depression lasting at least 2 weeks -must experience 5 or more of the following symptoms in 2 weeks to be diagnosed with a major depressive episode: • feeling low most of the day for most days • decreased interest in activities • substantial weight loss, significant change in appetite • fidgeting, random movement (i.e. pacing) • decreased energy • sense of guilt or worthlessness • lack of focus or ability to make decisions • repeated thoughts of death and suicide" "Medications for depression - CORRECT ANSWER -SSRIs -SNRIs -NDRIs -TCAs -MAOIs" "Selective Serotonin Reuptake Inhibitors (SSRIs) - CORRECT ANSWER -Action: • inhibits 5-HT (serotonin) reuptake -Ex: • citalopram • escitalopram • fluoxetine • paroxetine • sertraline -Common Side Effects: • nausea, agitation, headache, and sexual dysfunction" "Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) - CORRECT ANSWER -Action: • inhibits 5-HT (serotonin) reuptake • inhibit NE reuptake (↑ energy, focus) • increase DA in prefrontal cortex (↑ cognition) -Ex: • desvenlafaxine • duloxetine • levomilnacipran • venlafaxine -Common Side Effects: • nausea, sweating, insomnia, tremors, sexual dysfunction" "Norepinephrine Dopamine Reuptake Inhibitors (NDRI) - CORRECT ANSWER -Action: • inhibit DA reuptake (↑alertness, motivation) • inhibit NE reuptake (↑energy)" "Tricyclic Antidepressants (TCAs) - CORRECT ANSWER -Action: • inhibits the reuptake of serotonin & norepinephrine • blocks norepinephrine, histamine, & acetylcholine receptors -Ex: • amitriptyline • clomipramine • desipramine • doxepin -Common Side Effects: • dry mouth, constipation, blurred vision, urinary retention sedation, weight gain, hypotension, tachycardia, and sexual dysfunction" "Monoamine Oxidase Inhibitors (MAOIs) - CORRECT ANSWER -Action: • increases norepinephrine & serotonin by inhibiting the enzyme that inactivates it -Ex: • isocarboxazid • phenelzine • tranylcypromine -Common Side Effects: • sedation, dizziness, sexual dysfunction, & hypertensive crisis" "Bipolar disorder medications: Lithium - CORRECT ANSWER -Lithium • Action: alters cation transport in the nerve & muscle • Indication: euphoric mania, rapid cycling, maintenance therapy • Adverse Effects: GI effects, tremor, polyuria• Monitor plasma levels• Use to protect against suicide" "Bipolar disorder medications: lamotrigine (Lamictal) - CORRECT ANSWER -lamotrigine (Lamictal) • Action: affects sodium channel ion transport & enhances the activity of y-aminobutyric acid (GABA) • Indication: maintenance therapy, monotherapy • Adverse Effects: benign rash (risk for rare Stevens-Johnson Syndrome rash & multi-organ failure), GI effects, dizziness, h/a• equal in efficacy to lithium • Take at bedtime due to sedation side effect" "Bipolar disorder medications: valproic acid (Depakene) - CORRECT ANSWER -valproic acid (Depakene) • Action: affects ion transport and enhances the activity of y-aminobutyric acid (GABA) • Indication: acute mania, mixed mood, comorbid substance use, multiple prior episodes • Adverse Effects: GI effects, weight gain • equal to lithium • Monitor plasma levels • If using with lamotrigine decrease valporate levels by 50%" "Bipolar disorder medications: Second generation antipsychotics - CORRECT ANSWER -Second generation antipsychotics • Action: DA, NE, and 5-HT receptor antagonists • Indication: acute bipolar depression, acute manic or mixed episodes, bipolar maintenance/adjunct • Adverse Effects: weight gain, sedation, GI effects • Monitor for extrapyramidal effects • XR form may improve adherence • injection may improve adherence" "Bipolar disorder medications: carbemazepine (Tegretol) - CORRECT ANSWER -carbemazepine (Tegretol) • Action: glutamate voltage gated sodium & calcium channel blocker (Glu-CB • Indication: acute mania, mixed mood • Adverse Effects: GI effects, sedation, hyponatremia, neutopenia, rash (Stevens-Johnson Syndrome) • Monitor plasma levels • Consider genotyping clients with Asian ancestry HLA-B 2501 allele increases risk of Steven-Johnson Syndrome" "pediatric anxiety disorders - CORRECT ANSWER -among the most diagnosed mental health disorders • 9.4% of U.S. children & youth (5.8 billion) -can result in: • academic & social impairment • persist into adulthood • comorbid mental health problems, depression most common -Anxiety Disorders by age • 1.3% of children aged 3-5 years • 6.6% of children aged 6-11 years • 10.5% of children aged 12-17 years" "prevalence of OCD - CORRECT ANSWER -between 1%-4% • 80% show symptoms by age 18" "common symptoms of anxiety in children - CORRECT ANSWER -Trouble concentrating -Fatigue -Irritability -Muscle tension -Frequent urination -Upset stomach -Trouble sleeping -Restlessness -Nightmares -Fidgeting -Poor performance at school" "clinical presentation of pediatric: GAD - CORRECT ANSWER -excessive or unrealistic worry about everyday life events that are out of proportion to the impact of the events -only one physical or cognitive symptom is required for diagnosis • whereas three symptoms are required for adult diagnosis" "clinical presentation of pediatric: Separation Anxiety Disorder - CORRECT ANSWER -Separation anxiety typically peaks between 10-18 months and ends by about 3 years (developmentally appropriate in children under 3) -disorder occurs when a child experiences intense or prolonged worry or fear about being separated from family members or other individuals with whom the child is close • may be triggered by stress that leads to separation from a loved • diagnosed when symptoms are excessive for the developmental age and interfere with daily functioning" "risk factors for separation anxiety - CORRECT ANSWER -recent loss of a family member -exposure to disturbing subject matter -female sex -positive family history -shy personality -extended parental conflict or absences -relocation due to moving" "clinical presentation of pediatric: Social Anxiety Disorder or Social Phobia - CORRECT ANSWER -intense fear of social situations, including performing in front of others • scrutiny, embarrassment, or humiliation are possible -clinically significant distress and interferes with daily activities -Physical symptoms: • blushing, stammering, nausea, difficulty speaking, racing heart -may manifest with: • tantrums, crying, clinging, freezing up, withdrawing from social situations -Dx: symptoms consistently present in similar situations for 6 months+ & anxiety must occur in settings with peers, not just interactions with adults" "clinical presentation of pediatric: Selective Mutism (SM) - CORRECT ANSWER -ind. unable to speak in certain social settings they find stressful • school or work -can communicate well in other settings • home or with family -usually starts between ages 2-4 -more common in females -commonly comorbid with social anxiety disorder -Dx: based on the client's medical, developmental, & family history • Collaboration with speech-language pathologist is recommended -Tx: psychological treatment & referral for speech & language therapy" "screening for anxiety in children - CORRECT ANSWER -commonly used tool: Screen for Child Anxiety Related Disorders (SCARED) tool Child Version • screen for several types of anxiety disorders generalized anxiety panic disorder separation anxiety social anxiety -total score of 25 or more points indicates a potential anxiety disorder • higher scores, more specific results" "Treatment for Pediatric Anxiety Disorders - CORRECT ANSWER -psychotherapy • Cognitive-behavioral therapy (CBT) most common -pharmacologic • First-line is SSRIs • Benzodiazepines used sometimes for short-term tx especially for certain phobias, fear of dental/medical tx" "Eliana Swan (DOB: 6/18/20XX)is a 10-year-old who has a history of dental phobia after a traumatic experience during a root canal. She must have a tooth extraction and her mother is concerned that Eliana will not be able to tolerate the procedure without "something to help her relax." Eliana weighs 71 pounds. In the activity below, write an appropriate prescription for Eliana. - CORRECT ANSWER Rx: lorazepam 1.0 mg tablet PO Disp: 1.5 tablets Sig: Take 45 to 90 minutes before the procedure Refills: 0 Rationale: A benzodiazepine, such as lorazepam, may be prescribed for children with specific phobias r/t dental or medical treatments. An appropriate dose of lorazepam is 0.05 mg/kg PO as a single dose 45 to 90 minutes before the procedure." "Obsessive-Compulsive Disorder - CORRECT ANSWER -Onset is gradual • 25% cases emerge between 8-12 years -Symptoms: • persistent, intrusive thoughts (obsessions) • repetitive behaviors performed to decrease obsession-related anxiety (compulsions) -diagnostic criteria: obsessions & compulsions time-consuming (1 hour per day) & disrupt normal routines, functioning, or relationships. -Common in children: washing, checking, ordering, fear of catastrophe" "small subset of children with OCD, the diagnosis is associated with ________________ - CORRECT ANSWER streptococcal infections -acronym PANDAS • pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections used to identify this subset lab test called the Cunningham Panel to aid in identifying children with PANDAS PANDAS is treated with antibiotics while OCD symptoms are treated with a combination of CBT & SSRIs" "Children with PANDAS and SSRIs: - CORRECT ANSWER -Children with PANDAS may be particularly sensitive to side effects of SSRIs • important to begin treatment with low doses & increase slowly" "screen for OCD in children and adolescents - CORRECT ANSWER -commonly used tool: Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) • children & adolescents aged 6-17" "Tx of OCD in children and adolescents - CORRECT ANSWER -First-line treatment for mild to moderate OCD is CBT • used alone or in combination with medication SSRI or clomipramine • If symptoms persist after 2+ trials of an SSRI or clomipramine & failure to respond to CBT, tx may be augmented with an atypical antipsychotic" "The PMHNP administers the CY-BOCS to August and his score is 13. Which of the following are the next appropriate steps for August? Select all that apply. refer August to his pediatrician for a Cunningham Panel recommend exposure and response prevention therapy for August recommend psychoeducation for August's grandmother recommend starting an SSRI - CORRECT ANSWER refer August to his pediatrician for a Cunningham Panel recommend exposure and response prevention therapy for August recommend psychoeducation for August's grandmother Rationale: August's rapid onset of symptoms consistent with OCD indicates the need to rule out PANDAS from a streptococcal infection. August's score of 13 indicates mild OCD. Starting with exposure and response prevention therapy is an appropriate initial treatment, as is providing psychoeducation for August's grandmother. If symptoms persist after therapy, an SSRI may be added to the treatment plan." "Body Dysmorphic Disorder (BDD) - CORRECT ANSWER -type of obsessive-compulsive disorder • ind. becomes preoccupied with one or more perceived flaws in physical appearance that are not visible or appear slight to others -typically begins in adolescence -engage in repetitive behaviors: • checking mirrors, excessive grooming, picking, seeking reassurance -Hospitalization may be indicated for clients with severe BDD" "screening tools for Body Dysmorphic Disorder (BDD) - CORRECT ANSWER -Body Dysmorphic Disorder Questionnaire (BDDQ) -The BDD Yale-Brown Obsessive Compulsive Scale for Adolescents (BDD-YBOCS-A) • determine the severity of the diagnosis • Scores range from 0-to 48, 20 indicate presence of BDD, higher score = more severe" "Body Dysmorphic Disorder (BDD) tx - CORRECT ANSWER -CBT • reduce symptoms & improving mood & quality of life • used alone or in combination with medication typically an SSRI" "Pediatric Mood Disorders - CORRECT ANSWER -unipolar depression most prevalent at 4.4% -bipolar disorder (BPD) approx. 4% • symptoms appearing early as age 5 -disruptive mood dysregulation disorder (DMDD) 1-3%" "important concerns for adolescents with mood disorders - CORRECT ANSWER substance use and suicide" "Mood Disorders in Children & Adolescents: Unipolar Depression - CORRECT ANSWER -Pediatric unipolar or major depression typically presents in late childhood or early adolescence -more than half of youth diagnosed with adolescent-onset depression are diagnosed with BPD at adult age -Adolescent girls 3x more likely to experience depression than boys • boys higher rate of depression before puberty" "Mood Disorders in Children & Adolescents: Unipolar Depression Clinical Presentation - CORRECT ANSWER • Sadness or irritability • Academic decline • Withdrawal from friends and family • Loss of interest in things of past enjoyment • Problems with sleep • Appetite &/or weight changes • Feelings of guilt or being misunderstood • Clinging to a parent • Unexplained crying • Thoughts or actions of self-harm" "Unipolar Depression Screening - CORRECT ANSWER -The U.S. Preventive Services Task Force (USPSTF) • depression screening in adolescents 12- 18 years -no current recommendations for screening children younger than 12 -The American Academy of Pediatrics • Guidelines for Adolescent Depression in Primary Care (GLAD-PC) recommend the Patient Health Questionnaire-9 Modified for Adolescents (PHQ-9A)" "Unipolar Depression Tx - CORRECT ANSWER -goals & outcomes developed in collaboration with client & family -safety plan for addressing acute crises or suicidality established at the time of diagnosis or initial tx • safety concerns are highest at this time -psychotherapy & medication • CBT & SSRIs fluoxetine, the frontline choice due to its efficacy, low cost, and side effect profile" "Although SSRIs are typically well tolerated in this population, adverse effects can occur including behavioral activation which can manifest as: - CORRECT ANSWER -irritability, agitation, and impulsivity. • Generally, these symptoms are time-limited and can be managed with care and support." "!!!!!!!!!!This SSRI has been associated with increased suicidal thinking & actions in children & adolescents & should not typically be used to treat depression in this population!!!!!!!!!!!!!!!!!!!! - CORRECT ANSWER Paroxetine" "SSRI tx phases: - CORRECT ANSWER -Acute phase: Aim is to achieve a significant reduction or disappearance of symptoms for 8-12 weeks. -Continuation phase: Aim is to consolidate treatment gains and prevent relapse for 6 to 12 months. -Maintenance phase: Aim is to prevent relapse by continuing treatment for those with recurrent, severe, or chronic depression." "Initiating SSRI with child or adolescent - CORRECT ANSWER *Start at low doses with dose increase or med change only after 4 weeks *Symptom severity should be assessed every 1-2 weeks after initiating medication along with continuous monitoring of suicidality" "Mood Disorders in Children & Adolescents: Bipolar Disorder (BPD) - CORRECT ANSWER -Dx of children before puberty remains controversial -Common comorbidities: ADHD, anxiety disorders, oppositional defiant disorder, learning disorders, substance use -Clinical Presentation: more rapidly cycling moods & mixed episodes, symptoms of both mania and depression together" "Bipolar Disorder (BPD) Screening - CORRECT ANSWER -Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children interview tool • validated tool for use in diagnosing BPD" "Treatment for pediatric BPD - CORRECT ANSWER -typically includes a combination of medication and psychotherapy • mood stabilizers & antipsychotic medications help tx symptoms/stabilize pt so they are able to participate in psychotherapy -Psychosocial interventions • education, skill-building, and lifestyle modifications -Motivational interviewing: promote medication adherence -Family-focused therapy: help youths at high risk for BPD increase the time between mood episodes through psychoeducation, communication, & problem-solving skills training -Interpersonal and Social Rhythm Therapy (IRPT): help clients manage life with a mood disorder by promoting regularity in daily routines" "Nic, a 15-year-old, was admitted to an inpatient adolescent psychiatric unit. He has been diagnosed with bipolar I disorder and has suicidal ideations. Match the scenario with the most appropriate initial medication: divalproex lithium lurasidone - CORRECT ANSWER lithium Rationale: Lithium can reduce suicidality; clients who have suicidal ideations should be carefully monitored until therapeutic levels are reached." "Toni, a 17-year-old, has complaints of irritability, racing thoughts, high energy, and low mood. Match the scenario with the most appropriate initial medication: divalproex lithium lurasidone - CORRECT ANSWER divalproex Rationale: Divalproex is the preferred drug for adolescents with bipolar disorder with mixed features." "Antoine, an 11-year-old, was diagnosed with bipolar depression. Match the scenario with the most appropriate initial medication: divalproex lithium lurasidone - CORRECT ANSWER lurasidone Rationale: Lurasidone is an appropriate treatment for bipolar depression in adults and children over 10 years of age." "Kenzie is a 10-year-old who was diagnosed with bipolar I disorder, acute manic episode. Since she has trouble swallowing pills, she was initially started on lithium immediate release solution 12 milliequivalents per liter (mEq) three times daily. She returns to the PMHNP's office one week after her initial diagnosis for follow-up and lab work. Kenzie's mother reports that although her mood seems less severe, she continues to have high levels of irritability, loss of appetite, insomnia, and "mood swings". Kenzie's lithium level is 0.7 mEq/L. Which of the following is the most appropriate management strategy for Kenzie? increase lithium dosage to 16 mEq three times daily decrease lithium dosage to 12 mEq three times daily stop lithium and begin divalproex - CORRECT ANSWER increase lithium dosage to 16 mEq three times daily Rationale: Kenzie's lithium level is subtherapeutic; therapeutic levels are between 0.8-1.2 mEq/L for clients experiencing acute mania. Since Kenzie is still experiencing symptoms, it is appropriate to increase her dose. The maximum dosage for immediate release solution in children 7 and older weighing greater than 30 kg is 48 mEq/day given in 2-3 divided doses." "When should the PMHNP schedule a follow-up visit for Kenzie? one day five days one week two weeks - CORRECT ANSWER five days Rationale: The time to efficacy for lithium is 3-5 days in children; a follow-up visit or phone call at 5 days will allow the PMHNP to reassess the efficacy of Kenzie's new dose." "Mood Disorders in Children & Adolescents: Disruptive Mood Dysregulation Disorder (DMDD) - CORRECT ANSWER -first appeared in the DSM-5 in 2013 -Clinical Presentation: • chronic, persistent irritability & anger • frequently experience problems at home, school, or with peers -DSM-5-TR criteria: • severe, recurrent (3 times per week) outbursts of temper • mood between outbursts of temper is chronically irritable or angry most of the day, every day, and is observable to others • symptoms have been present 12 months with no more than 3 consecutive months without symptoms • symptoms are present in at least 2 of 3 settings (home, school, or with peers), severe degree in at least one setting • diagnosis cannot be made before age 6 or after age 18 years • onset begins before age 10 • behaviors cannot be attributed to another mental disorder -cannot coexist with dx of bipolar disorder, intermittent explosive disorder, or ODD • symptoms of both DMDD and ODD, the diagnosis of DMDD should be used" "Disruptive Mood Dysregulation Disorder (DMDD) Screening - CORRECT ANSWER -The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children (KSADS-PL) • validated for use in combination with the DMDD module" "Disruptive Mood Dysregulation Disorder (DMDD) Tx - CORRECT ANSWER -psychotherapies and medication • CBT used to teach children & adolescents to manage thoughts & feelings that contribute to depression or anxious feelings -Parent training • help teach parents techniques to interact with their children, reduce aggression/irritability, improve the parent-child relationship -intense cases, risk of harm to self or others, severe disruptions in functioning, or substance abuse: • intensive outpatient treatment • residential treatment • inpatient psychiatric treatment -Med classes: • stimulant medications: help decrease irritability • Antidepressants: assist with irritability & other mood problems -Atypical antipsychotics: help control severe outbursts of temper" "develop schizophrenia - CORRECT ANSWER -Many genes play a role • as do epigenetic factors • Heritability as high as 79% -gene-environment interaction -Environmental Triggers: • Regular Cannabis Use • Exposure to Early Life Trauma Sexual Abuse Emotional Abuse Emotional Neglect Bullying" "schizophrenia Neuroanatomy - CORRECT ANSWER -Mesocortical & ventromedial prefrontal cortex: negative and affective symptoms -Dorsolateral: cognitive symptoms -Orbitofrontal & connections to the amygdala: aggressive, impulsive symptoms" "Brain Circuits Affected in Schizophrenia: - CORRECT ANSWER -Dopamine Pathways • explain the (+) & (-) symptoms seen in schizophrenia & psychosis" "Dopamine Role in Psychosis - CORRECT ANSWER -leading hypothesis • psychosis & schizophrenia associated with dysfunction of neurotransmitter dopamine (DA) Traditionally surplus of dopamine" "Glutamate Role in Psychosis - CORRECT ANSWER -primary excitatory neurotransmitter -implicated in the overactivity of mesolimbic DA pathway in schizophrenia -Glutamate hypoactivity may result in lost activation of the mesocortical dopamine pathway leading to negative symptoms of schizophrenia" "GABA is the primary _________ neurotransmitter - CORRECT ANSWER inhibitory" "Clinical domains of psychosis symptoms: Positive Symptoms - CORRECT ANSWER -Hallucinations -Delusions -Thought disorder -Hostility -Excitability" "Clinical domains of psychosis symptoms: Motor Symptoms - CORRECT ANSWER -Motor delay -Dyscoordination -EPS, e.g. • Parkinsonism • Dyskinesia" "Clinical domains of psychosis symptoms: Affective Symptoms - CORRECT ANSWER -Depression -Anxiety -Suicidality" "Clinical domains of psychosis symptoms: Cognition - CORRECT ANSWER -Attention -Working memory -Verbal memory -Visual memory -Executive functioning -Processing speed -Social conditioning" "Clinical domains of psychosis symptoms: Negative Symptoms - CORRECT ANSWER -Affective flattening -Alogia -Anhedonia -Amotivation -Asociality" "Hallucinations: - CORRECT ANSWER -perceptual experiences in the absence of external stimuli • Auditory • Visual • Tactile (feeling) • Olfactory • Gustatory (tasting)" "Delusions: - CORRECT ANSWER -fixed false, irrational beliefs • Persecution: delusions related to being threatened, victimized, or spied on • Reference: delusions related to receiving personal messages from television (tv), radio, or actions of others • Somatic: delusions related to the body, including illness or the presence of foreign objects (e.g. Sometimes people believe there are objects in their bodies; for example they might think they are infested with insects.) • Grandeur: delusions related to beliefs of special abilities or powers • Control: delusions that actions and thoughts are controlled by others" "Thought Disorder: - CORRECT ANSWER -impairment in the process of thinking & difficulty organizing thoughts in a logical pattern • incoherent speech • loose associations • meaningless words • perseveration" "Disorganized behavior: - CORRECT ANSWER -disordered or impaired behavior or communication • childlike silliness • unpredictable agitation • inappropriate clothing for the weather • poor hygiene" "Erica is a 24-year-old with a newly diagnosed schizophreniform disorder. She is a current smoker. She does not use alcohol or other drugs. She has no medical history. Which of the following would be the least appropriate initial medication for Erica? aripiprazole lurasidone olanzapine quetiapine - CORRECT ANSWER olanzapine Rationale: Olanzapine requires up to 30% increased dosage for clients who smoke concurrently. Initiating a medication that does not interact with smoking is preferable." "Tony is a 56-year-old who has recently been diagnosed with schizophrenia. He takes amiodarone for a history of cardiac dysrhythmias. He does not use alcohol or other drugs. He is a nonsmoker. Which of the following is the most appropriate medication for Tony? aripiprazole lurasidone quetiapine risperidone - CORRECT ANSWER risperidone Rationale: Amiodarone is a moderate CYP3A4 inhibitor. Risperidone does not interact with CYP3A4 inhibitors or inducers." "Jenny is a 22-year-old who has been prescribed aripiprazole 15 mg/day for the past 8 months. She has gained approximately 30 lbs. during treatment. Jenny's psychiatric symptoms have been managed well on aripiprazole and she has no other adverse effects. What is the most appropriate initial intervention for Jenny? switch to a different antipsychotic medication prescribe metformin refer to a bariatric specialist - CORRECT ANSWER prescribe metformin Rationale: Prescribing metformin as an adjunct treatment to assist with weight loss associated with antipsychotics is appropriate. Jenny is well-managed on the current dose of aripiprazole; switching to a different medication is not indicated at this time. Referral to a bariatric specialist may be indicated if the client continues to gain weight but is not indicated as the most appropriate initial intervention." "Scott is a 33-year-old who is currently without housing. He has been unable to adhere to his prescribed oral medication regimen. The PMHNP recommends a long-acting intramuscular form of medication. Scott is willing to try but would like to receive the medication at the community clinic near the shelter where he is staying. Which medication option is the least appropriate for Scott at this time? aripiprazole monohydrate olanzapine paliperidone palmitate risperidone - CORRECT ANSWER olanzapine Rationale: Olanzapine must be given in a registered health care facility with available emergency medical services. The client receiving olanzapine must be monitored for 3 hours post-injection." "Autism Spectrum Disorder (ASD) - CORRECT ANSWER -neurological and developmental disorder -impacts communication, relationships with others, learning, behavior -1-2% of population -all racial, ethnic, and socioeconomic groups -Males 4x more likely than females -Factors with increased risk: • having a sibling with ASD • having older parents • having certain genetic conditions: Fragile X syndrome Down syndrome • very low birth weight -spectrum disorder • wide variation in the types and severity of symptoms symptoms typically appear in first 2 years of life" "DSM-5-TR criteria for ASD - CORRECT ANSWER -persistent deficits in communication and social interaction across multiple contexts and restrictive, repetitive patterns of behavior, interests, or activities -Symptoms must appear early in development and can cause clinically significant impairment in functioning -severity is classified based on the level of support needed by the individual" "ASD Diagnosis and Screening - CORRECT ANSWER -The American Academy of Pediatrics (AAP) recommends that all children be screened for ASD • Providers perform basic developmental screenings at children's 18-month and 24-month well-child visits • demonstrate developmental differences in behavior or functioning require additional evaluation, typically performed by a team of ASD specialists child psychologist, speech-language pathologist, occupational therapist, developmental pediatrician, or neurologist -Dx based on clinical observations, observations in a natural setting, caregiver history, or self-reports" "ASD different developmental screening tools available - CORRECT ANSWER -Screening tools: • Ages and Stages Questionnaires (ASQ) • Communication and Symbolic Behavior Scales (CSBS) • Parents' Evaluation of Developmental Status (PEDS) • Modified Checklist for Autism in Toddlers (MCHAT) • Screening Tool for Autism in Toddlers and Young Children (STAT) -Diagnostic tools • Autism Diagnosis Interview - Revised (ADI-R) • Autism Diagnostic Observation Schedule - Generic • Childhood Autism Rating Scale (CARS) • Gilliam Autism Rating Scale - Second Edition (GARS-2)" "Early signs of ASD include: - CORRECT ANSWER -avoiding eye contact -showing little interest in peers or caretakers -limited language abilities -frustration with minor changes in routine -repetitive behaviors" "Quentin is a 4-year-old who presents with his parents for evaluation. Before the appointment, the psychiatric mental health nurse practitioner (PMHNP) read a report submitted to the office by Quentin's preschool teacher, who notes that he is easily distracted, often "fidgety", and has difficulty waiting his turn. He gets frustrated when the school schedule changes and has difficulty interacting with his peers. He does not seem bothered by his lack of friends; rather, he chooses most times to play alone, and he resists playing group games with the class. When pressed to engage, Quentin becomes agitated. The teacher reports that he responds appropriately when asked a question directly, but rarely makes eye contact and avoids physical contact with others. Based on the information provided by the teacher, which of the following diagnoses should be considered potential diagnoses for Quentin? attention-deficit/hyper - CORRECT ANSWER attention-deficit/hyperactivity disorder (ADHD) autism spectrum disorder (ASD) social anxiety disorder social communication disorder Rationale: Based on the information provided by the teacher, Quentin's current list of differential diagnoses includes ADHD, ASD, social anxiety disorder, and social communication disorder. Additional information is required to narrow the list." "Quentin's parents express that preschool has been Quentin's first interaction with other children. He is an only child, and his parents were able to work opposite shifts to avoid sending him to daycare during the pandemic. His mother notes that he has never been an overly affectionate child but tolerates being hugged and kissed by his parents. She reports that he has limited eye contact with both parents, and they find his emotions "hard to read." He has always preferred playing alone to engaging with his parents in play, and his father describes his play as "methodical in that he doesn't seem to play pretend with his toys, but instead lines them up or takes them apart. He only has interest in cars and doesn't play with other toys." His parents both endorse that Quentin seems to have difficulty interacting with adults who visit the home; he seems to struggle with engaging in conversation typical for a - CORRECT ANSWER yes Rationale: Quentin meets the DSM-5-TR (APA, 2022) criteria for autism spectrum disorder, including persistent deficits in social communication and interaction across multiple contexts manifested as deficits in social-emotional reciprocity, nonverbal communication, and the ability to develop relationships. He also displays repetitive behavior patterns with his toys and difficulties with changes to routines and transitions." "Based on the information provided, which of the following specifiers are appropriate for Quentin at this time? Select all that apply. requiring very substantial support requiring substantial support requiring support with accompanying intellectual impairment with accompanying language impairment associated with a known genetic or other medical condition or environmental factor associated with a neurodevelopmental, mental, or behavioral problem with catatonia - CORRECT ANSWER requiring support Rationale: Specifiers describe current symptoms and may change over time.