NR-606- MIDTERM EXAM
What44are44barriers44to44seeking44mental44health44care44in44children44&44adolescents?44
-44answer--Children-
44Although44children44and44adolescents44may44seek44help,44they44usually44drop44out44b
efore44treatment44is44effective44due44to44poverty,44language44barriers,44living44in44comm
unities44with44lack44of44resources,44stressors44such44as44family44issues,44violence44in44t
he44community,44unstable44housing,44unemployment44and44food44insecurity.
Adolescents-
44Many44parents44lack44an44access44to44sufficient44care44for44their44children44or44themse
lves44during44perinatal.44Parents44and44adolescents44are44reluctant44to44receive44care44
due44to44the44stigmas44or44negative44perceptions44towards44mental44health44services.
What44are44some44barriers44that44pregnant44women44are44faced44with44when44attemptin
g44to44seek44care44for44mental44health?44-44answer--Perinatal-
44cost,44scheduling44conflicts44and44high44staff44turnover44rate44causes44issues44for44fa
milies44seeking44care.44
Less44than4415%44of44women44get44treated44for44PPD.
Explain44the44sensorimotor44stage44(ages440-2)44according44to44Piaget.44-44answer--
Children44experience44the44world44through44their44senses44and44motor44responses.44Th
e44goal44of44this44stage44is44object44permanence.
Explain44the44pre-operational44stage44(ages442-7)44according44to44Piaget.44-44answer--
Children44think44symbolically44and44think44very44concrete.44They44learn44to44use44words
44or44pictures44to44represent44objects.44They44are44egocentric44and44have44difficulty44se
eing44things44from44others'44perspectives.44Pre-
operational44thinking44is44very44concrete.44So44think44very44straight44forward44when44yo
u44are44teaching44them:
"You44know44how44its44hard44for44you44to44sit44still44and44pay44attention44in44school?44Th
is44medicine44will44help44you"44.44Imagination44is44still44strong44however44abstract44thinki
ng44is44difficult.44Think44Ade's44responses.44THE44ABSENCE44OF44OBJECT44PERMAN
ENCE.
Explain44the44concrete-operational44stage44(ages447-11)44according44to44Piaget.44-
44answer--
Children44begin44to44think44more44logical44and44organized44about44concrete44events.44T
,hey44begin44to44reason44inductively,44from44specific44information44to44principles.44Using4
4similes44within44teaching44is44great44for44this44group.
"It's44kind44of44like44you've44got44a44great44bike.44The44brakes44just44need44some44fixing.
44The44medication44is44like44fixing44the44brakes."44Time,44space,44and44quantity44is44und
erstood44however44not44as44separate44concepts.
Explain44the44Formal-
operational44stage44(ages441244and44up)44according44to44Piaget.44-44answer--
Adolescents44and44young44adults44begin44to44reason44abstractly44and44can44consider44h
ypothetical44problems.44They44begin44to44think44more44about44moral,44philosophical,44et
hical,44social,44and44political44issues.
"This44medication44can44help44you44ignore44distractions44so44you44can44complete44tasks
.44They44can44also44help44with44self-
control,44which44may44help44you44get44along44better44with44your44friends44and44parents.4
4Do44you44have44any44concerns44about44taking44the44medication?"44They44begin44to44st
art44planning44at44this44age.
-50%44of44lifetime44mental44illnesses44begin44at44the44age44of4414.
-50%44of44children44ages448-1544are44not44treated44for44mental44illnesses44-44answer--
How44does44consent44work44with44children?44-44answer--
Parents44may44decide44whether44to44allow44treatment44if44the44child44is44unable44to44pro
vide44true44informed44consent44(Preston44et44al.,442021).44Although44children44may44not4
4be44able44to44give44legal44consent,44they44should44be44included44in44discussions44about
44medication44and44treatment44whenever44possible.44Child44input44into44treatment44deci
sions44may44encourage44treatment44adherence.44Positive44experiences44with44providers
44and44treatment44can44help44instill44the44perception44that44treatment44is44beneficial,44wh
ich44can44support44positive44mental44health44behaviors44in44the44future.
What44should44be44included44in44the44consent44form44and44documentation44when44discu
ssing44information44(such44as44taking44psychotropic44drugs)44with44pregnant44patients?4
4-44answer--Informed44consent44should44include44
side44effects
possible/rare44side44effects44to44mother44and44baby44regardless44of44incidence
the44patient's44decision44to44continue44or44discontinue44treatment
potential44risks44of44continuing44or44discontinuing44treatment
Referral44to44perinatal44psychiatrist44if44the44patient44is44at44high44risk44or44on44a44high-
risk44medication.
What44are44some44points44that44PMHNP44should44take44into44consideration44when44pre
scribing44medications44for44children?
Metabolism,44Excretion,44Side44effects44-44answer--Metabolism-
44Children44have44a44higher44metabolism44than44adults44and44may44require44higher44dos
e44of44medication44per44body44weight.44When44they44reach44puberty44in44adolescents44i
s44when44the44medication44is44usually44titrated44down44because44they44are44reaching44a
44metabolism44of44an44adult.
,Excretion-
44Children44are44going44to44excrete44medications44quicker44due44to44high44metabolism.44
Ensure44to44use44proper44prescribing44protocol44per44weight.44Again,44may44need44high
er44doses44than44adults.
Side44effects-
44Children44may44not44understand44that44they44are44experiencing44side44effects44so44the
44PMHNP44must44ensure44to44educate44and44include44the44child44in44prescribing44educa
tion44as44well44as44be44keen44to44side44effects44that44the44child44may44or44may44not44des
cribe.44(Listen44to44the44parents44as44well).44Allow44children44to44participate44in44the44tre
atment44plan
PMHNP44are44mandatory44reporters44and44MUST44report44any44forms44of44child44abuse
,44neglect44or44suspicions44of44such44to44the44authorities.44There44are44federal44and44sta
te44guidelines44that44we44are44expected44to44follow.44What44is44this44federal44guideline44
called?44-44answer--The44Child44Abuse44Prevention44and44Treatment44Act
What44are44some44prescribing44considerations44for44women44who44are44pregnant?44-
44answer--
The44physiologic44changes44that44occur44during44pregnancy44impact44the44pharmacokin
etics44of44many44medications.44An44increase44in44blood44plasma44level44may44increase4
4the44distribution44volume44of44certain44medications.44Hormonal44changes44in44CYP4504
4enzyme44activations44may44increase44or44decrease44drug44metabolism.44Increased44re
nal44blood44flow44and44glomerular44filtration44rate44may44speed44the44excretion44of44med
ications.44Monitoring44of44serum44drug44levels44can44help44inform44drug44dosing44for44so
me44medications;44generally,44however,44providers44must44rely44on44careful44symptom44
monitoring44and44adjust44dosages44as44necessary44to44achieve44optimal44symptom44ma
nagement44at44the44lowest44beneficial44dose44(Payne,442020).
_______44stigma44includes44policies,44regulations,44or44laws44that44intentionally44or44uni
ntentionally44lead44to44discrimination.44This44stigma44can44limit44access44to44resources44
and44other44opportunities,44thereby44impacting44the44well-
being44of44the44stigmatized44group.44
A44program44policy44that44prohibits44individuals44from44using44specific44forms44of44presc
ribed44medication44for44addiction44(MAT)44treatment44is44an44example44of44structural44sti
gma.44-44answer--Institutional44or44structural44stigmas
_____44stigma44is44when44Individuals44working44in44[medication-
assisted44treatment]44MAT44experience44discrimination44and44prejudice44from44other44h
ealthcare44professionals,44especially44abstinent44treatment44professionals44who44disagr
ee44with44the44use44of44medications44to44treat44opioid44use44disorders.44
This44discrimination44and44prejudice44stem44at44times44from44stigma44toward44addiction4
4diagnoses,44and44at44other44times44toward44unique44features44of44MAT44itself.44The44ex
periences44of44addiction44treatment44professionals44illustrate44how44medical44interventio
ns44can44mark44clients44and44professionals44in44ways44that44affect44client44care,44and44t
hus44must44be44added44to44the44scope44of44destigmatization44efforts"44(p.44324).44-
44answer--Interventional44stigmas
, _______44stigma44encompasses44the44attitudes,44beliefs,44and44behaviors44of44groups44
or44individuals44which44form44a44stereotype44that44creates44an44emotional44reaction44or4
4prejudice44and44results44in44discrimination.44
A44stereotypic44belief44that44individuals44choose44to44use44alcohol44or44other44drugs44an
d44blame44them44for44their44substance44use44disorder44is44an44example44of44this44stigma
.44-44answer--Public44stigma
_______44stigma44refers44to44the44shame44individuals44internalize44about44negative44ste
reotypes.44For44individuals44affected44by44SUDs,44this44stigma44may44lead44to44feelings4
4of44being44flawed44or44unworthy44of44love44or44connection.44It44may44also44prevent44the
m44from44seeking44help.44-44answer--self-stigma
Name44some44risk44factors44for44maternal44mental44health44disorders:44-44answer--
lack44of44social44support
familial/personal44history44of44depression
pregnancy44complications
poor44relationship44quality
smoking
unintended44pregnancy
life44complications
chronic44physical44conditions
prior44pregnancy44with44infant/fetal44loss
What44is44the44DSM-544criteria44for44maternal44depression?44-44answer--
The44patient44has44to44have44at44least44544symptoms44for44a44two44week44period44to44be
44diagnosed44with44MDD.44
Peripartum44onset44is44a44specifier44that44is44used44if44the44depression44occurs44during4
4pregnancy44UP44TO44the44first44four44weeks44after44birth.
What44are44some44symptoms44of44maternal44depression?44-44answer--
low44mood,44anxiety,44avoiding44people,44negative44thoughts,44fatigue,44guilt44and44diffic
ulty44focusing,44feeling44like44one44"lost44themselves",44insecurity,44anhedonia,44feeling4
4overwhelmed,44lack44of44control44over44emotions,44weight44loss,44indecisiveness,44recu
rrent44suicidal44ideation,44psychomotor44agitation
specific44concerns44about44the44baby44or44parenting,44including44a44sense44of44numbne
ss44or44disconnection44from44the44baby44or44guilt44about44not44being44a44good44mother
As44a44PMHNP,44what44scale44is44used44to44screen44for44depression44in44pregnant44wo
men?44Discuss44the44scale44ratings44-44answer--
The44Edinburgh44Postnatal44Depression44scale-
44It44can44used44during44pregnancy44and44after44delivery.
A44score44cutoff44of441044is44in44the44indicator44of44depression.
Discuss44the44scoring44for44the44EPD44scale44along44with44the44PMHNP44interventions44
-44answer--·44Less44than448:44Depression44not44likely:44continue44support
What44are44barriers44to44seeking44mental44health44care44in44children44&44adolescents?44
-44answer--Children-
44Although44children44and44adolescents44may44seek44help,44they44usually44drop44out44b
efore44treatment44is44effective44due44to44poverty,44language44barriers,44living44in44comm
unities44with44lack44of44resources,44stressors44such44as44family44issues,44violence44in44t
he44community,44unstable44housing,44unemployment44and44food44insecurity.
Adolescents-
44Many44parents44lack44an44access44to44sufficient44care44for44their44children44or44themse
lves44during44perinatal.44Parents44and44adolescents44are44reluctant44to44receive44care44
due44to44the44stigmas44or44negative44perceptions44towards44mental44health44services.
What44are44some44barriers44that44pregnant44women44are44faced44with44when44attemptin
g44to44seek44care44for44mental44health?44-44answer--Perinatal-
44cost,44scheduling44conflicts44and44high44staff44turnover44rate44causes44issues44for44fa
milies44seeking44care.44
Less44than4415%44of44women44get44treated44for44PPD.
Explain44the44sensorimotor44stage44(ages440-2)44according44to44Piaget.44-44answer--
Children44experience44the44world44through44their44senses44and44motor44responses.44Th
e44goal44of44this44stage44is44object44permanence.
Explain44the44pre-operational44stage44(ages442-7)44according44to44Piaget.44-44answer--
Children44think44symbolically44and44think44very44concrete.44They44learn44to44use44words
44or44pictures44to44represent44objects.44They44are44egocentric44and44have44difficulty44se
eing44things44from44others'44perspectives.44Pre-
operational44thinking44is44very44concrete.44So44think44very44straight44forward44when44yo
u44are44teaching44them:
"You44know44how44its44hard44for44you44to44sit44still44and44pay44attention44in44school?44Th
is44medicine44will44help44you"44.44Imagination44is44still44strong44however44abstract44thinki
ng44is44difficult.44Think44Ade's44responses.44THE44ABSENCE44OF44OBJECT44PERMAN
ENCE.
Explain44the44concrete-operational44stage44(ages447-11)44according44to44Piaget.44-
44answer--
Children44begin44to44think44more44logical44and44organized44about44concrete44events.44T
,hey44begin44to44reason44inductively,44from44specific44information44to44principles.44Using4
4similes44within44teaching44is44great44for44this44group.
"It's44kind44of44like44you've44got44a44great44bike.44The44brakes44just44need44some44fixing.
44The44medication44is44like44fixing44the44brakes."44Time,44space,44and44quantity44is44und
erstood44however44not44as44separate44concepts.
Explain44the44Formal-
operational44stage44(ages441244and44up)44according44to44Piaget.44-44answer--
Adolescents44and44young44adults44begin44to44reason44abstractly44and44can44consider44h
ypothetical44problems.44They44begin44to44think44more44about44moral,44philosophical,44et
hical,44social,44and44political44issues.
"This44medication44can44help44you44ignore44distractions44so44you44can44complete44tasks
.44They44can44also44help44with44self-
control,44which44may44help44you44get44along44better44with44your44friends44and44parents.4
4Do44you44have44any44concerns44about44taking44the44medication?"44They44begin44to44st
art44planning44at44this44age.
-50%44of44lifetime44mental44illnesses44begin44at44the44age44of4414.
-50%44of44children44ages448-1544are44not44treated44for44mental44illnesses44-44answer--
How44does44consent44work44with44children?44-44answer--
Parents44may44decide44whether44to44allow44treatment44if44the44child44is44unable44to44pro
vide44true44informed44consent44(Preston44et44al.,442021).44Although44children44may44not4
4be44able44to44give44legal44consent,44they44should44be44included44in44discussions44about
44medication44and44treatment44whenever44possible.44Child44input44into44treatment44deci
sions44may44encourage44treatment44adherence.44Positive44experiences44with44providers
44and44treatment44can44help44instill44the44perception44that44treatment44is44beneficial,44wh
ich44can44support44positive44mental44health44behaviors44in44the44future.
What44should44be44included44in44the44consent44form44and44documentation44when44discu
ssing44information44(such44as44taking44psychotropic44drugs)44with44pregnant44patients?4
4-44answer--Informed44consent44should44include44
side44effects
possible/rare44side44effects44to44mother44and44baby44regardless44of44incidence
the44patient's44decision44to44continue44or44discontinue44treatment
potential44risks44of44continuing44or44discontinuing44treatment
Referral44to44perinatal44psychiatrist44if44the44patient44is44at44high44risk44or44on44a44high-
risk44medication.
What44are44some44points44that44PMHNP44should44take44into44consideration44when44pre
scribing44medications44for44children?
Metabolism,44Excretion,44Side44effects44-44answer--Metabolism-
44Children44have44a44higher44metabolism44than44adults44and44may44require44higher44dos
e44of44medication44per44body44weight.44When44they44reach44puberty44in44adolescents44i
s44when44the44medication44is44usually44titrated44down44because44they44are44reaching44a
44metabolism44of44an44adult.
,Excretion-
44Children44are44going44to44excrete44medications44quicker44due44to44high44metabolism.44
Ensure44to44use44proper44prescribing44protocol44per44weight.44Again,44may44need44high
er44doses44than44adults.
Side44effects-
44Children44may44not44understand44that44they44are44experiencing44side44effects44so44the
44PMHNP44must44ensure44to44educate44and44include44the44child44in44prescribing44educa
tion44as44well44as44be44keen44to44side44effects44that44the44child44may44or44may44not44des
cribe.44(Listen44to44the44parents44as44well).44Allow44children44to44participate44in44the44tre
atment44plan
PMHNP44are44mandatory44reporters44and44MUST44report44any44forms44of44child44abuse
,44neglect44or44suspicions44of44such44to44the44authorities.44There44are44federal44and44sta
te44guidelines44that44we44are44expected44to44follow.44What44is44this44federal44guideline44
called?44-44answer--The44Child44Abuse44Prevention44and44Treatment44Act
What44are44some44prescribing44considerations44for44women44who44are44pregnant?44-
44answer--
The44physiologic44changes44that44occur44during44pregnancy44impact44the44pharmacokin
etics44of44many44medications.44An44increase44in44blood44plasma44level44may44increase4
4the44distribution44volume44of44certain44medications.44Hormonal44changes44in44CYP4504
4enzyme44activations44may44increase44or44decrease44drug44metabolism.44Increased44re
nal44blood44flow44and44glomerular44filtration44rate44may44speed44the44excretion44of44med
ications.44Monitoring44of44serum44drug44levels44can44help44inform44drug44dosing44for44so
me44medications;44generally,44however,44providers44must44rely44on44careful44symptom44
monitoring44and44adjust44dosages44as44necessary44to44achieve44optimal44symptom44ma
nagement44at44the44lowest44beneficial44dose44(Payne,442020).
_______44stigma44includes44policies,44regulations,44or44laws44that44intentionally44or44uni
ntentionally44lead44to44discrimination.44This44stigma44can44limit44access44to44resources44
and44other44opportunities,44thereby44impacting44the44well-
being44of44the44stigmatized44group.44
A44program44policy44that44prohibits44individuals44from44using44specific44forms44of44presc
ribed44medication44for44addiction44(MAT)44treatment44is44an44example44of44structural44sti
gma.44-44answer--Institutional44or44structural44stigmas
_____44stigma44is44when44Individuals44working44in44[medication-
assisted44treatment]44MAT44experience44discrimination44and44prejudice44from44other44h
ealthcare44professionals,44especially44abstinent44treatment44professionals44who44disagr
ee44with44the44use44of44medications44to44treat44opioid44use44disorders.44
This44discrimination44and44prejudice44stem44at44times44from44stigma44toward44addiction4
4diagnoses,44and44at44other44times44toward44unique44features44of44MAT44itself.44The44ex
periences44of44addiction44treatment44professionals44illustrate44how44medical44interventio
ns44can44mark44clients44and44professionals44in44ways44that44affect44client44care,44and44t
hus44must44be44added44to44the44scope44of44destigmatization44efforts"44(p.44324).44-
44answer--Interventional44stigmas
, _______44stigma44encompasses44the44attitudes,44beliefs,44and44behaviors44of44groups44
or44individuals44which44form44a44stereotype44that44creates44an44emotional44reaction44or4
4prejudice44and44results44in44discrimination.44
A44stereotypic44belief44that44individuals44choose44to44use44alcohol44or44other44drugs44an
d44blame44them44for44their44substance44use44disorder44is44an44example44of44this44stigma
.44-44answer--Public44stigma
_______44stigma44refers44to44the44shame44individuals44internalize44about44negative44ste
reotypes.44For44individuals44affected44by44SUDs,44this44stigma44may44lead44to44feelings4
4of44being44flawed44or44unworthy44of44love44or44connection.44It44may44also44prevent44the
m44from44seeking44help.44-44answer--self-stigma
Name44some44risk44factors44for44maternal44mental44health44disorders:44-44answer--
lack44of44social44support
familial/personal44history44of44depression
pregnancy44complications
poor44relationship44quality
smoking
unintended44pregnancy
life44complications
chronic44physical44conditions
prior44pregnancy44with44infant/fetal44loss
What44is44the44DSM-544criteria44for44maternal44depression?44-44answer--
The44patient44has44to44have44at44least44544symptoms44for44a44two44week44period44to44be
44diagnosed44with44MDD.44
Peripartum44onset44is44a44specifier44that44is44used44if44the44depression44occurs44during4
4pregnancy44UP44TO44the44first44four44weeks44after44birth.
What44are44some44symptoms44of44maternal44depression?44-44answer--
low44mood,44anxiety,44avoiding44people,44negative44thoughts,44fatigue,44guilt44and44diffic
ulty44focusing,44feeling44like44one44"lost44themselves",44insecurity,44anhedonia,44feeling4
4overwhelmed,44lack44of44control44over44emotions,44weight44loss,44indecisiveness,44recu
rrent44suicidal44ideation,44psychomotor44agitation
specific44concerns44about44the44baby44or44parenting,44including44a44sense44of44numbne
ss44or44disconnection44from44the44baby44or44guilt44about44not44being44a44good44mother
As44a44PMHNP,44what44scale44is44used44to44screen44for44depression44in44pregnant44wo
men?44Discuss44the44scale44ratings44-44answer--
The44Edinburgh44Postnatal44Depression44scale-
44It44can44used44during44pregnancy44and44after44delivery.
A44score44cutoff44of441044is44in44the44indicator44of44depression.
Discuss44the44scoring44for44the44EPD44scale44along44with44the44PMHNP44interventions44
-44answer--·44Less44than448:44Depression44not44likely:44continue44support
