Walden University NURS 6660 Midterm Exam (pdf) | 2026/2027 |
PMHNP Q&A | Psychiatry
**1. Jack is a 3-year-old boy who is being evaluated for developmental delay.
The mental status examination is significant for an inability to stack two
blocks or draw a circle. The PMHNP also appreciates the inability to attend to
any task for more than a few seconds. These findings indicate an
abnormality in:**
A) Social relatedness
B) Thought process and content
C) Motor behavior
D) Judgment and insight
**Correct Answer: C**
**Rationale:** The inability to stack two blocks or draw a circle indicates fine
motor coordination difficulties, while the inability to attend to tasks suggests
motor planning and executive function deficits. These are abnormalities in
motor behavior and developmental milestones. Social relatedness, thought
process, and judgment are not directly assessed by these tasks.
---
**2. During the mental status exam of Oliver, a 4-year-old child, the PMHNP
appreciates that he appears to be having transient visual and auditory
hallucinations. The PMHNP knows that the best approach to this finding is to
consider that:**
A) This is most consistent with early-onset schizophrenia
B) An organic brain disorder should be ruled out
C) These are normal findings in very young children
,D) Comprehensive psychiatric assessment is indicated
**Correct Answer: B**
**Rationale:** Transient hallucinations in a 4-year-old should prompt a
medical workup to rule out organic brain disorders such as seizures,
infections, or metabolic conditions. While hallucinations can occur in young
children, they are not considered normal and warrant a thorough evaluation.
Early-onset schizophrenia is rare and not the first consideration.
---
**3. Jason is a 17-month-old male who is referred for evaluation of an
unusually high level of irritability. His mother says he cries "all the time," and
sometimes he just cannot be comforted. Comprehensive assessment of
Jason's irritability should include all the following EXCEPT:**
A) A comprehensive medical assessment
B) Standardized developmental measures
C) Assessment without the parents present
D) Observation of Jason during play
**Correct Answer: C**
**Rationale:** Assessment of a 17-month-old should always include the
parents, as young children cannot provide a reliable history and may exhibit
different behaviors when separated from caregivers. A comprehensive
medical assessment, developmental measures, and play observation are all
essential components of the evaluation.
,---
**4. Which of the following is the most common anxiety disorder of
childhood?**
A) Generalized anxiety disorder
B) Separation anxiety disorder
C) Social anxiety disorder
D) Obsessive-compulsive disorder
**Correct Answer: B**
**Rationale:** Separation anxiety disorder is the most common anxiety
disorder in childhood, affecting approximately 4-5% of children. It typically
emerges between ages 6 and 12 and involves excessive fear or anxiety
about separation from attachment figures.
---
**5. Phillip is a 5-year-old boy who is in care after being referred for failure to
speak at school. He has been in kindergarten for 5 months, and initially his
teacher thought he was just shy. However, it has become increasingly
apparent that he flat out will not speak at school. Phillip's parents are
adamant that there is not any problem at home and that Phillip talks with
them and his older sister routinely. The PMHNP suspects that Phillip has
selective mutism, which is closely related to:**
A) A history of sexual abuse
B) Fetal alcohol syndrome
C) Early onset schizophrenia
, D) Social anxiety disorder
**Correct Answer: D**
**Rationale:** Selective mutism is closely related to social anxiety disorder.
Children with selective mutism consistently fail to speak in specific social
situations (such as school) despite speaking in other settings. This is often an
extreme manifestation of social anxiety, and the two conditions frequently
co-occur.
---
**6. When evaluating treatment strategies for a 14-year-old patient with
obsessive-compulsive disorder (OCD), the PMHNP considers that evidence-
based data from the Pediatric OCD Treatment Study (POTS) suggests that
best outcomes are achieved with cognitive behavioral therapy (CBT) and:**
A) Clomipramine (Anafranil)
B) Sertraline (Zoloft)
C) Aripiprazole (Abilify)
D) Lithium (Eskalith)
**Correct Answer: B**
**Rationale:** The Pediatric OCD Treatment Study (POTS) found that the
combination of CBT and sertraline (an SSRI) was superior to either treatment
alone for pediatric OCD. SSRIs are first-line pharmacotherapy for pediatric
OCD, with sertraline being one of the most studied options.
---
PMHNP Q&A | Psychiatry
**1. Jack is a 3-year-old boy who is being evaluated for developmental delay.
The mental status examination is significant for an inability to stack two
blocks or draw a circle. The PMHNP also appreciates the inability to attend to
any task for more than a few seconds. These findings indicate an
abnormality in:**
A) Social relatedness
B) Thought process and content
C) Motor behavior
D) Judgment and insight
**Correct Answer: C**
**Rationale:** The inability to stack two blocks or draw a circle indicates fine
motor coordination difficulties, while the inability to attend to tasks suggests
motor planning and executive function deficits. These are abnormalities in
motor behavior and developmental milestones. Social relatedness, thought
process, and judgment are not directly assessed by these tasks.
---
**2. During the mental status exam of Oliver, a 4-year-old child, the PMHNP
appreciates that he appears to be having transient visual and auditory
hallucinations. The PMHNP knows that the best approach to this finding is to
consider that:**
A) This is most consistent with early-onset schizophrenia
B) An organic brain disorder should be ruled out
C) These are normal findings in very young children
,D) Comprehensive psychiatric assessment is indicated
**Correct Answer: B**
**Rationale:** Transient hallucinations in a 4-year-old should prompt a
medical workup to rule out organic brain disorders such as seizures,
infections, or metabolic conditions. While hallucinations can occur in young
children, they are not considered normal and warrant a thorough evaluation.
Early-onset schizophrenia is rare and not the first consideration.
---
**3. Jason is a 17-month-old male who is referred for evaluation of an
unusually high level of irritability. His mother says he cries "all the time," and
sometimes he just cannot be comforted. Comprehensive assessment of
Jason's irritability should include all the following EXCEPT:**
A) A comprehensive medical assessment
B) Standardized developmental measures
C) Assessment without the parents present
D) Observation of Jason during play
**Correct Answer: C**
**Rationale:** Assessment of a 17-month-old should always include the
parents, as young children cannot provide a reliable history and may exhibit
different behaviors when separated from caregivers. A comprehensive
medical assessment, developmental measures, and play observation are all
essential components of the evaluation.
,---
**4. Which of the following is the most common anxiety disorder of
childhood?**
A) Generalized anxiety disorder
B) Separation anxiety disorder
C) Social anxiety disorder
D) Obsessive-compulsive disorder
**Correct Answer: B**
**Rationale:** Separation anxiety disorder is the most common anxiety
disorder in childhood, affecting approximately 4-5% of children. It typically
emerges between ages 6 and 12 and involves excessive fear or anxiety
about separation from attachment figures.
---
**5. Phillip is a 5-year-old boy who is in care after being referred for failure to
speak at school. He has been in kindergarten for 5 months, and initially his
teacher thought he was just shy. However, it has become increasingly
apparent that he flat out will not speak at school. Phillip's parents are
adamant that there is not any problem at home and that Phillip talks with
them and his older sister routinely. The PMHNP suspects that Phillip has
selective mutism, which is closely related to:**
A) A history of sexual abuse
B) Fetal alcohol syndrome
C) Early onset schizophrenia
, D) Social anxiety disorder
**Correct Answer: D**
**Rationale:** Selective mutism is closely related to social anxiety disorder.
Children with selective mutism consistently fail to speak in specific social
situations (such as school) despite speaking in other settings. This is often an
extreme manifestation of social anxiety, and the two conditions frequently
co-occur.
---
**6. When evaluating treatment strategies for a 14-year-old patient with
obsessive-compulsive disorder (OCD), the PMHNP considers that evidence-
based data from the Pediatric OCD Treatment Study (POTS) suggests that
best outcomes are achieved with cognitive behavioral therapy (CBT) and:**
A) Clomipramine (Anafranil)
B) Sertraline (Zoloft)
C) Aripiprazole (Abilify)
D) Lithium (Eskalith)
**Correct Answer: B**
**Rationale:** The Pediatric OCD Treatment Study (POTS) found that the
combination of CBT and sertraline (an SSRI) was superior to either treatment
alone for pediatric OCD. SSRIs are first-line pharmacotherapy for pediatric
OCD, with sertraline being one of the most studied options.
---
