NURS 6660N FINAL EXAM 2 QUESTION AND ANSWERS (75/75 POINTS). DOWNLOAD TO SCORE A

NURS 6660N FINAL EXAM 2 – QUESTION AND ANSWERS (74/75 POINTS) • Question 1 1 out of 1 points Conventional antipsychotics are not first-line interventions in early-onset schizophrenia due to the risk of dystonic reactions. However, when children are not responsive to first-line therapy with atypical antipsychotics, which of the following is the most appropriate conventional choice? Selected Answer: D. Chlorpromazine • Question 2 1 out of 1 points The therapeutic outcomes for children with disorders of written expression are most favorable when they are characterized by: Selected Answer: Intensive, continuous administration of individually tailored, one-on-one expressive and creative writing therapy • Question 3 1 out of 1 points Linda is a 5-year-old girl who has persistent pica; she was finally referred for care when her kindergarten teacher became alarmed by her eating of potentially toxic nonfood substances. Linda’s mother admits during the history that Linda has been doing this for years, but thought it was not a big deal since Linda didn’t eat anything dangerous. Linda’s mother must work two jobs and essentially did not bother to pursue Linda’s unusual symptom because it didn’t seem unsafe. While discussing management strategies with Linda’s mother, the PMHNP counsels that the most rapidly successful treatment strategy appears to be: Selected Answer: A. Aversion therapy • Question 4 0 out of 1 points Rumination is a feeding disorder most commonly seen in infants, but it can occur at any point in the lifespan. Characteristic findings in infants include: Selected Answer: C. Failure to thrive • Question 5 1 out of 1 points Katelyn is a16-year-old girl who presents for therapy with her mother and father. Katelyn was born with male genitalia but has felt like a female “all of her life.” She says she knew something was different as far back as she can remember. She always wanted to wear her mother’s clothes and makeup and play with other girls. Katelyn started dressing and openly identifying as a girl when she was 13 years old, and her parents are trying to be supportive but they are struggling. Most recently Katelyn has developed an intimate partner relationship with Jennifer, a 15-year-old girl who was gender-assigned female at birth and identifies as a female. Katelyn’s father does not understand the relationship. The PMHNP explains that Katelyn: Selected Answer: C. Is a transgender female who identifies as lesbian • Question 6 1 out of 1 points All the following are true with respect to making a diagnosis of major depressive disorder in children except: Selected Answer: C. There must be somatic or psychomotor complaints. • Question 7 1 out of 1 points Donna is a 16-year-old transgender female who has been through extensive individual and family counseling and is ready to start hormone therapy with estrogen, progesterone, and testosterone-blocking agents. When counseling her specifically about the risks, benefits, and required monitoring of hormonal therapy, the PMHNP advises Donna that: Selected Answer: C. Sterility is a probable consequence of hormone therapy • Question 8 1 out of 1 points The leading cause of death in youths living in juvenile residential facilities is: Selected Answer: A. Suicide • Question 9 1 out of 1 points The PMHNP is working with a pediatrician colleague on a journal article to increase awareness and improve diagnostic strategies for early-onset bipolar disorder. Based upon a review of the longitudinal research on this disorder, the literature review of this article should include all the following except: Selected Answer: C. Higher socioeconomic status and lifetime psychosis are predictors of more rapid cycling in early-onset bipolar disorder • Question 10 1 out of 1 points Tiana is a 10-year-old girl who is being referred for evaluation because her school performance is appreciably below what is expected at her age. Historically she has been a very happy child, likes school, and looks forward to going. However, over the last several months her teacher reports that she is much slower than her peers in reading, and she appears to be upset and withdrawn when asked to read in class. The PMHNP would expect additional report from the teacher to include all the following except: Selected Answer: A. Inability to copy correctly from a printed text • Question 11 1 out of 1 points Which of the following statements best characterized the treatment course and progression of bulimia nervosa? Selected Answer: A. Cognitive behavioral therapy is considered the benchmark, first-line treatment. • Question 12 1 out of 1 points Kelly is a 14-year-old female who has finally been referred for management of anorexia nervosa. She was diagnosed almost 1 year ago with the food-restricting subtype, but attempts to get her into psychiatric care were unsuccessful. She continues to be resistant but her caloric intake is now < 400 daily and she finally appears to be unable to sustain the supraphysiologic levels of exercise that she has maintained to try and “keep her weight down.” She is 5’2” tall and weighs 82 lbs., which is approximately 75% of ideal body weight for her height. Her vital signs are stable and surprisingly there are no profound laboratory or ECG abnormalities. When counseling Kelly and her parents about the recommended course of treatment, the PMHNP advises that Kelly will require: Selected Answer: B. Hospitalization for controlled weight gain • Question 13 1 out of 1 points In which demographic is depression twice as prevalent in girls as compared to boys? Selected Answer: C. Adolescents • Question 14 1 out of 1 points Debbie is a 10-year-old female who has been referred to remediation therapy for her reading disorder. While designing her treatment program, the PMHNP knows that the most current strategies are characterized by: Selected Answer: C. Focusing the child’s attention to the connections between speech sounds and spelling • Question 15 1 out of 1 points Which of the following symptom clusters is most likely in a 16-year-old male with major depressive disorder? Selected Answer: D. Pervasive anhedonia, hopelessness, and severe psychomotor retardation • Question 16 1 out of 1 points The etiology of childhood depression is multifactorial and may include biological factors. Which of the following is a true statement with respect to hormonal studies in depressed children? Selected Answer: A. Prepubertal children having a depressive episode secrete significantly more growth hormone during sleep than nondepressed children. • Question 17 1 out of 1 points Jared is a 6-year-old boy who comes to the PMHNP for an evaluation with his father. The father reports that he is worried about Jared because he has had problems fitting in at school ever since he started kindergarten. He does not have any friends at school and does not seem to know how to play with others. Dad reports that Jared has never been “very talkative” and sometimes switches from one topic to another without any reason. When considering early-onset schizophrenia, the PMHNP recognizes that which of the following must be present? Selected Answer: B. Deteriorating function over the last several months • Question 18 1 out of 1 points Learning disorders affect at least 5% of all school-aged children in the United States. Since 1975, Public Law 94-142 mandates that all states provide free, appropriate services to all children. Among the various types of learning disorders, the PMHNP knows that the overwhelming majority are: Selected Answer: A. Reading disorders • Question 19 1 out of 1 points While the core features of schizophrenia are essentially the same in children as they are in adults, the presentation or characterization is sometimes very different given developmental issues. Unlike adults with schizophrenia, children with schizophrenia do not have: Selected Answer: B. Poverty of speech content • Question 20 1 out of 1 points The PMHNP is working with rural primary care providers to increase awareness of mental health disorders in infancy and early childhood. The program includes a session on screening for feeding disorders in infants. If an infant is either observed by the provider or reported by the parent to frequently suck the tongue rhythmically or appear to strain with his or her back arched and then swallow, the examiner should consider the possibility of: Selected Answer: D. Inadequate emotional attachment • Question 21 1 out of 1 points Which of the following is a true statement with respect to avoidant/restrictive food intake disorder? Selected Answer: B. Approximately 70% of infants who persistently refuse food continue to have some eating problems during childhood. • Question 22 1 out of 1 points Regarding pediatric suicide, which of the following is a true statement? Selected Answer: A. Worldwide, suicide very rarely occurs in children who have not reached puberty. • Question 23 1 out of 1 points The PMHNP is working with a couple who has been trying for years to conceive and is now ready to pursue adoption as an option. They are considering all possibilities; private vs. government-mediated adoption, adopting from another country, adopting a child of a different race or ethnicity, adopting an older child rather than an infant, and adopting a child who is currently in foster care vs. one who lives in an orphanage. While counseling this couple, the PMHNP advises them that: Selected Answer: A. Younger children adopted from foster care settings have the best outcomes • Question 24 1 out of 1 points The PMHNP is treating Pam, a 13-year-old female, for moderate-to-severe major depressive disorder. In addition to cognitive behavioral therapy, the PMHNP discusses with the patient and her father the plan to begin sertraline, 50 mg daily, then titrate the dose up when tolerance is established. Pam’s father has researched this medication and is concerned because he read about the risk of increased suicidal ideation. The most appropriate response is to tell Pam’s father that: Selected Answer: C. More recent research suggests that this is not accurate and that treatment actually decreases risk of suicide • Question 25 1 out of 1 points Treatment of early-onset schizophrenia can be challenging due to the paucity of evidence-based support for various pharmacotherapeutics and nonpharmacologic interventions. In a recent study comparing olanzapine to clozapine, outcomes were assessed with the Clinical Global Impression of Severity of Symptoms Scale and Schedule for the Assessment of Negative/Positive Symptoms. Clozapine was found to demonstrate statistically significant superiority in which outcome measure? Selected Answer: A. Alleviating negative symptoms • Question 26 1 out of 1 points While counseling the parents of Joshua, a 9-year-old patient with developmental coordination disorder, the PMHNP advised that the treatment will include: Selected Answer: A. Modified physical education • Question 27 1 out of 1 points The literature indicates that boys whose fathers died before the age of 13 are at a greater risk for the development of depression as compared to controls. This is consistent with which general theory of depression etiology? Selected Answer: D. Stress-diathesis • Question 28 1 out of 1 points Standardized instructional programs used in the management of reading disorders include all the following except: Selected Answer: D. Woodcock-Johnson Psychoeducational Battery • Question 29 1 out of 1 points The PMHNP suspects that Wesley, an 8-year-old male, has a reading disorder. In kindergarten his teacher documented some suspicion for a disorder, but throughout first grade and now into second grade, he is clearly functioning below expected levels.. He becomes increasingly anxious when asked to read in school. Which aspect of Wesley’s history would support the risk for this diagnosis? Selected Answer: D. Attention deficit hyperactivity disorder • Question 30 1 out of 1 points When counseling the parents of an intersex neonate, the PMHNP recognizes that the current standard of care is to counsel toward: Selected Answer: B. Flexible sex rearing • Question 31 1 out of 1 points Jessica is a 26-month-old female who is being evaluated because she will not eat. Her parents report that she just flat out will not eat her meals. Her mother says that she has followed all the pediatrician’s suggestions: she has eliminated any snacks or drinks between meals, and she has offered a variety of foods, including those that Jessica seemed to enjoy previously. Jessica is not sick; has no problems with vomiting or elimination abnormalities. Jessica’s parent say that her pediatrician is not concerned, but they are not comfortable with what appears to be an almost complete absence of food intake. While considering a diagnosis of avoidant food intake disorder the PMHNP knows that any of the following would fulfill the diagnostic criteria except: Selected Answer: A. An irritable, apathetic, or anxious affect • Question 32 1 out of 1 points Rose is a 13-year-old girl who is being evaluated as part of a family assessment; the primary patient is Rose’s 8-year-old brother who is demonstrating behavior of concern and is having a court-ordered evaluation. During the family assessment, it becomes apparent that Rose’s mother is very concerned that Rose is a tomboy. The mother, who is very elegant, is distressed by Rose’s persistent “tomboy” behavior and worries that Rose might become a lesbian, which would be “unacceptable” to the family. More detailed evaluation of Rose reveals that she is experiencing some sexual reflection. She excels at sports and has always preferred rough and tumble play, but she doesn’t see anything wrong with that. She thinks she is sexually attracted to one of her female teachers, and sometimes fantasizes about her. Rose just began menstruating 3 months ago, and while she has had a boyfriend at school, she is not sexually active in any way; they have kissed a few times, and she likes it, but she has no plans to take it any further. Otherwise Rose seems well adjusted, worries about her brother, and dismisses her mother’s concerns as “silly.” Which of the following statements best characterizes Rose? Selected Answer: D. Rose does not appear to have concerns about her gender identity of sexuality and no further evaluation is indicated. • Question 33 1 out of 1 points Caylee is a 5-year-old girl who is referred for evaluation by child protective services. She was recently removed from her biological family and placed in foster care as her home environment was reportedly unsafe due to conditions of extreme neglect. Her foster mother reports that Caylee is very quiet and withdrawn and always appears sad and disinterested in her surroundings; however, she becomes very irritable when anything unexpected or unplanned occurs. The foster mother became very concerned when it appeared that Caylee was hallucinating. The PMHNP considers that: