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

NR 606 WEEK 8 FINAL EXAM 2025/2026 COMPLETE QUESTIONS AND COMPLETE ANSWERS WITH RATIONALE 100% GUARANTEED SUCCESS “Stimulant Medications: Methylphenidate - CORRECT ANSWER -Low risk of adverse effects -Available formulations: • Ritalin - available in immediate release (IR) and extended release (XR) available in beads that may be sprinkled on food for children who cannot swallow pills • Concerta biphasic - combined immediate and delayed release in one medication • Daytrana - patch applied in AM and removed after 9 hour" "Stimulant Medications: Dexmethylphenidate (Focalin) - CORRECT ANSWER -Available in IR and ER -More potent than Ritalin -High risk of adverse effects" "Stimulant Medications: Amphetamine (Adzenys) - CORRECT ANSWER -available in orally disintegrating ER formula for children who cannot swallow pills -Avoid prescribing when an MAOI has been used within 14 days" "Stimulant Medications: Dextroamphetamine (Adderall) - CORRECT ANSWER -Available in IR and extended-release formulations -Often dosed in morning (IR or XR) with an evening or evening prn (IR) dose if med effects diminish prior to end of school, study or the workday -Most abused & diverted prescription stimulant" "Stimulant Medications: Lisdexamfetamine (Vyvanse) - CORRECT ANSWER -Biologically inactive until metabolized by the body (Prodrug) -Less abuse & diversion potential than other stimulants -Higher-cost medication" "Non-stimulant medication: Atomoxetine (Strattera) - CORRECT ANSWER -Noradrenergic (NRI) -Initial drug of choice for adults with ADHD -no abuse potential -tolerated well when prescribed in BID dosing -appropriate choice for comorbid substance abuse -may augment the effects of antidepressants & antianxiety meds -can be dosed at bedtime if fatigue is noted -unlikely to worsen tics" "Non-stimulant medication: Clonidine - CORRECT ANSWER -α 2 agonist • May be taken as monotherapy or with stimulant medications -enhances precortical function for better mental focus -appetite neutral -may help with sleep disturbances, administer at bedtime -adverse effects: • sedation, brain fog -monitor of BP closely during initial titration, risk of hypotension -tapered to avoid rebound hypertension post discontinuation" "Non-stimulant medication: guanfacine - CORRECT ANSWER -α 2 agonist • May be taken as monotherapy or with stimulant medications -may also be used for children with tics, sleep disturbances, or aggression -tolerability & convenience enhanced by once-daily oral controlled-release formulation -adverse effects: • sedation, headache, decreased appetite -reduced side-effect profile comparable to clonidine -bedtime administration to avoid daytime sedation" "Non-stimulant medication: Bupropion (Wellbutrin) - CORRECT ANSWER -Norepinephrine Dopamine Reuptake Inhibitor -off-label use for ADHD in adults -appropriate for clients with concurrent depression or tobacco abuse" "Rating scales for ADHD - CORRECT ANSWER -ADHD Rating Scales (ADHD-RS-IV and 5) -Swanson, Nolan and Pelham (SNAP) scale -Adult ADHD Self Report Scale (ASRS) -Vanderbilt scales -Conners' scales" "ADHD Comorbidities - CORRECT ANSWER >2/3 of children dx'd with ADHD have at least one coexisting psychiatric condition -learning disabilities -conduct disorders -tics -anxiety -depression -language disorders -SUD's • adolescents at increased risk *often tx ADHD 1st then comorbidities, may reduce overall stress levels, provide clearer picture of comorbid symptoms" "Tenzing is a 15-year-old who presents with restlessness, distractability, impulsive behavior, and inattention at school. He sleeps very little most nights and is often irritable. His parents describe him as "moody" and state that the smallest changes cause his mood to shift. He has had these symptoms for a few years, but recently the symptoms have gotten worse. The PMHNP diagnoses Tenzing with ADHD. Which of the following is the most likely comorbid diagnosis for Tenzing? bipolar disorder (BPD) unipolar depression generalized anxiety disorder - CORRECT ANSWER bipolar disorder (BPD) Rationale: After beginning medication for ADHD, Tenzing's remaining symptoms are consistent with bipolar disorder. Although mood dysregulation is common in clients with ADHD, mood changes are typically situational. Bipolar disorder presents with more random and cyclical mood changes. Both ADHD and BPD can present with irritability, sleep issues, restlessness, and impulsive behavior." "Onyenna is a 12-year-old whose teacher has concerns related to her school performance. She makes careless mistakes with her work and has difficulty listening in class and following directions. She frequently forgets to bring homework assignments and misplaces her personal belongings. She appears fatigued most days and complains of being tired frequently. Onyenna's parents endorse that she always seems irritable and disorganized at home, and they often have to ask her to complete tasks more than once. Onyenna states that she has no interest in school or extracurricular activities and does not care that she is not doing well in her classes. The PMHNP diagnoses Onyenna with ADHD and prescribes atomoxetine 25 mg once daily. Which of the following is the most likely comorbid diagnosis for Onyenna? bipolar disorder (BPD) unipolar depression generalized anxiety disorder learning disability - CORRECT ANSWER unipolar depression Rationale: After beginning medication for ADHD, Onyenna's remaining symptoms are consistent with unipolar depression. In children, depression often presents with irritability, fatigue, and a decreased interest in school or peer activities. Both ADHD and depression can cause diminished concentration and attention. Forgetfulness, carelessness, difficulty following directions and disorganization are common symptoms of ADHD with a predominantly inattentive presentation." "Addison is a 9-year-old who was diagnosed with ADHD predominantly combined presentation and was prescribed methylphenidate extended-release chewable tablets 20 mg once daily. Since she has started taking the medication, her appetite has decreased. She is 51 inches tall, and her initial weight was 58 lbs. She has lost 8 lbs. since beginning treatment. Which of the following medication adjustments is appropriate for Addison? implement stimulant holidays on weekends and non-school days decrease the dosage of methylphenidate extended-release to 10 mg daily switch to methylphenidate immediate-release 20 mg once daily switch to atomoxetine 25 mg once daily - CORRECT ANSWER implement stimulant holidays on weekends and non-school days Rationale: Stimulant holidays combined with caloric supplementation and monitoring can help offset stimulant-related weight loss. Switching to a non-stimulant medication may be warranted if drug holidays do not provide the desired result of weight stabilization." "ADHD nonpharmacologic tx - CORRECT ANSWER -Schools • educational support, behavioral interventions in the classroom, and accommodations -Psychotherapy • CBT • social and organizational skill training • family therapy. • Under age 6 American Academy of Pediatrics (AAP) recommends parent training in behavior management as a first-line intervention" "ADHD parent training in behavior management - CORRECT ANSWER -What parents learn: • Positive Communication • Positive Reinforcement • Structure and Discipline" "ADHD complementary and alternative medicine (CAM) interventions - CORRECT ANSWER -dietary approaches -nutritional supplements -mind/body practices • exercise • yoga • meditation -brain training programs" "disruptive behavioral disorders - CORRECT ANSWER -Disruptive, impulse-control, & conduct disorders -problems with emotional & behavioral regulation -often violate others' rights -bring ind. into conflict with social norms & authority figures -Behaviors often severe, frequent, occur in varied settings, can have serious consequences -more common in boys than girls -first onset in childhood or adolescence -Common diagnosis: • oppositional defiant disorder • conduct disorder • intermittent explosive disorder" "Conduct Disorder subtypes - CORRECT ANSWER -based on the age at onset: • childhood-onset symptoms before age 10 • adolescent-onset symptoms after age 10 • unspecified-onset subtype when the age at onset is unknown." "Conduct disorder pharmacologic tx - CORRECT ANSWER -atypical antipsychotics -SSRIs -Mood stabilizers -Beta blockers *Main component of tx is psychotherapy" "Intermittent explosive disorder (IED) - CORRECT ANSWER -low tolerance for frustration & adversity -essential features: freq impulsive or angry outbursts, often include temper tantrums, verbal assaults, or physical assaults towards others, animals, or property • unplanned • rapid onset • out of proportion to the trigger that elicited the response • lasts no longer than 30 minutes -Verbal outbursts: average of twice a week for three months -behavioral outbursts or tantrums that involve the destruction of property within 12 months -outbursts often lead to subjective distress or social or occupational dysfunction and poor life satisfaction and quality of life for the affected individuals." "Seamus is a 13-year-old who was referred to the psychiatric mental health nurse practitioner (PMHNP) by a family court judge for evaluation. Seamus was arrested after breaking into several cars on his street overnight and stealing loose change and small electronics. Seamus's parents endorse that he has had problems since he was a young boy. Starting in kindergarten, he has had "anger management" issues and argues with his parents and with teachers. He has difficulty sitting still in the classroom and was frequently disciplined for interrupting teachers, talking constantly, and running in the halls. At home, he often exhibits vindictive behavior towards his siblings and blames them for his actions. His parents describe him as "driven by a motor." He is irritable most of the time. He has never liked school and has struggled academically since first grade. He was suspended twice in elementary school for bullyi - CORRECT ANSWER Yes" "According to the DSM-5-TR, does Seamus meet the diagnostic criteria for conduct disorder? yes no unable to determine - CORRECT ANSWER Yes" "According to the DSM-5-TR, does Seamus meet the diagnostic criteria for intermittent explosive disorder? yes no unable to determine - CORRECT ANSWER No" "According to the DSM-5-TR, does Seamus meet the diagnostic criteria for ADHD? yes no unable to determine - CORRECT ANSWER Yes Rationale: Seamus meets diagnostic criteria for ODD, conduct disorder, and ADHD. His symptoms consistent with ODD include anger and irritability, argumentative and vindictive behavior, and blaming others. Symptoms consistent with conduct disorder include a history of repetitive, persistent behavior that violates societal norms within the past twelve months, including bullying, fighting, vandalism, theft, and truancy. His symptoms consistent with ADHD include "non-stop" energy, speaking out of turn, talkativeness, excessive running, and interrupting others. The behaviors occur in school and at home and have been present consistently for several years. His behaviors have negatively impacted his academic performance to the extent that he has been expelled from school." "disruptive, impulse-control, and conduct disorders assessment and screening - CORRECT ANSWER -comprehensive psychiatric evaluation • family hx • parenting styles • developmental hx • academic records -child-rated, caregiver-rated, and clinician-rated tools • Minnesota Impulse Disorders Interview (MIDI) diagnostically valuable" "federal law designed to ensure that children who have disabilities receive free appropriate public education (FAPE) - CORRECT ANSWER the Individuals with Disabilities Education Act (IDEA) -Initially passed in 1975 -IDEA ensures that: • Children with an identified disability receive individualized special education & services that address their needs. • Children with disabilities receive preparation for employment & independent living. • Children & families impacted by disability are protected under the law. • Federal agencies, states, localities, & educational service agencies that provide educational assistance to children with disabilities receive support." "protects the rights of individuals with disabilities who are enrolled in programs receiving federal financial assistance through the U.S. Department of Education - CORRECT ANSWER Section 504 of the Rehabilitation Act of 1973 -Support typically provided through implementation of Individualized Education Plans (IEP) or 504 plans • describe the services & accommodations that will be provided to students with qualifying disabilities" "Types of Feeding and Eating Disorders - CORRECT ANSWER -Anorexia nervosa -Bulimia nervosa -Binge eating disorder -Pica -avoidant/restrictive food intake disorder (ARFID)" "With repeated ingestion of a drug, the drug shows decreased effect. Increasing doses are required to achieve the effects noted with the original administration. - CORRECT ANSWER Tolerance" "State of adaptation produced with repeated administration of certain drugs so that physical symptoms occur when the drug is discontinued abruptly. - CORRECT ANSWER Dependence" "A change in behavior caused by biochemical changes in the brain after continued substance use characterized by preoccupation with and repeated use of a substance despite of negative outcomes. - CORRECT ANSWER Addiction" "Physiological and psychological reactions that occur when the use of a substance is stopped abruptly. - CORRECT ANSWER Withdrawal" "Condition following the ingestion of a substance resulting in changes in level of consciousness, cognition, perception, judgment, and behavior. - CORRECT ANSWER Intoxication" "Feeding and Eating Disorders Background - CORRECT ANSWER -severe, persistent disturbances in eating behaviors -approx. 9% of pop. in U.S. • costing $64.7 billion per year -second deadliest mental health condition, after opioid overdoses • approx. 10,200 deaths per year -typically develop in adolescence or young adulthood -more common in women -serious physical effects, contribute to psychological distress, disruptions in social functioning" "anorexia nervosa Dermatologic Cutaneous manifestations: - CORRECT ANSWER -Xerosis (dry, scaly skin) -Lanugo-like body hair (fine, downy, dark hair) -Telogen effluvium (hair loss) -Carotenoderma (yellowing) -Acne -Hyperpigmentation -Seborrheic dermatitis (erythema and greasy scales) -Acrocyanosis (cold, blue, and occasionally sweaty hands or feet) -Perniosis (painful or pruritic erythema) -Petechiae -Livedo reticularis (reddish-cyanotic circular patches) -Paronychia (inflamed lateral and posterior nail folds) -Pruritus -Striae distensae (erythematous or hypopigmented linear patches) -Slower wound healing" "_____% of individuals with anorexia nervosa excessively exercise - CORRECT ANSWER 40-80% -behavior often described as compulsive -excessive exercise • interferes with important tasks • exceeds 3 hrs/day • causes distress if unable to exercise • done at inappropriate times/places, no attempt to stop • done despite serious injury, illness, medical complications • beyond amount of calories consumed that day" "excessive exercise short term issues - CORRECT ANSWER dehydration fatigue chronic back pain injuries strains and sprains stress fxs" "excessive exercise long term complications - CORRECT ANSWER osteoporosis degenerative arthritis inability to menstruate reproductive issues heart issues" "_________ are common in individuals with anorexia nervosa - CORRECT ANSWER mood swings -major changes in mood and personality • happy and energetic to listless in hours can be due to imbalance in serotonin, dopamine, oxytocin, cortisol & leptin" "Which of the following are DSM-5-TR diagnostic criteria for anorexia nervosa? Select all that apply. -refusal to maintain a minimal bodyweight -pathological fear of gaining weight -distorted body image in which clients continue to insist they are overweight even when emaciated - CORRECT ANSWER -refusal to maintain a minimal bodyweight -pathological fear of gaining weight -distorted body image in which clients continue to insist they are overweight even when emaciated Rationale: Anorexia nervosa is an eating disorder where the main features include a refusal to maintain minimal body weight, a pathological fear of gaining weight, and a distorted body image in which sufferers continue to insist they are overweight." "Which of the following symptoms is consistent with anorexia nervosa binge-eating/purging type? avoiding eating to help control weight gain not being bothered about weight gain regularly using laxatives eating only certain types of foods - CORRECT ANSWER regularly using laxatives Rationale: Binge eating/purging type anorexia nervosa is a type of eating disorder that involves regularly engaging in purging activities, such as vomiting or the misuse of laxatives, diuretics, or enemas, to help control weight gain." "Aniyah is a 7-year-old who presents to the emergency department with complaints of abdominal pain. Her mother endorses a reduced appetite over the past three days, and she has not had a bowel movement in five days. Aniyah has no past medical history. She lives with her mother and older brother; her parents are separated, and her father moved out two months ago. Aniyah is in second grade; her developmental progress is age-appropriate. The medical team completed an assessment including an abdominal x-ray, which shows multiple rectangular radiopaque foreign bodies in the large intestine. After the x-ray was completed, Aniyah admitted to eating pencil erasers daily for the past two months. Which of the following is the most appropriate ICD-10-CM for Aniyah? F98.3 F50.8 F50.9 F32.9 - CORRECT ANSWER F98.3 Rationale: Aniyah meets the diagnostic criteria for pica: persistent eating of nonfood substances for at least a month, inappropriate to developmental level, and not a part of a culturally supported practice. The ICD-10-CM code for pica in children is F98.3 and for adults is F50.8." "Nichole is a 17-year-old who is 29 weeks pregnant with her first child. She has no past medical or psychiatric history. She was referred to the PMHNP (Psychiatric Mental Health Nurse Practitioner) by her obstetrician (OB) after she admitted to cravings for and consumption of paper on a regular basis. Nichole's OB ordered a complete blood count (CBC), comprehensive metabolic profile (CMP), and glucose tolerance test, all of which were normal. Nichole complains of mild heartburn and occasional constipation which she has been treating with over-the-counter antacids and laxatives. Nichole endorses eating about 3-4 sheets of copy paper each day, typically during her restroom breaks at school. She has been doing so for the past 8-10 weeks. She has not discussed this behavior with anyone other than her OB; she states that she finds the behavior "a bit weird and embarrassing." She states that other than eating paper, s - CORRECT ANSWER no Rationale: Although Nichole believes her behavior is "weird and embarrassing," she does not meet the diagnostic criteria for pica. Although she has been consuming nonfood substances for over a month, her behavior is occurring in the context of her pregnancy and the ingestion of paper does not pose potential medical risks." "Screening for Eating Disorders: SCOFF tool - CORRECT ANSWER -five-item measure • Do you make yourself SICK because you feel uncomfortably full? • Do you worry you have lost CONTROL over how much you eat? • Have you recently lost more than ONE stone (14 pounds or 6.35 kg) in three months? • Do you believe yourself to be FAT when others say you are too thin? • Would you say that FOOD dominates your life?" "Screening for Eating Disorders: PARDI - CORRECT ANSWER The Pica, ARFID, and Rumination Disorder Interview (PARDI) -clinical assessment tool -designed to assess & diagnose pica & ARFID -PARDI Parent/Carer 2-3 and Parent/Carer 4+ • modified for use with children and their caregivers -PARDI Self 8-13 and Self 14+ • used with adolescents -preliminary support for validity and reliability" "Anorexia Nervosa Tx - CORRECT ANSWER -multidisciplinary • psychotherapy & pharmacological interventions -Tx goals • restoration of sufficient nutrition • return to a healthy weight • reduction of excessive exercise • elimination of binge-purge & binge-eating behaviors • primary goal in medically stable AN pt is weight gain -Psychotherapy is essential -family therapy & CBT are effective modalities, can be implemented with tx manuals specific to anorexia nervosa -Medications can help address comorbid psychopathologies: • depressive disorders, anxiety disorders, OCDs -Psychotherapy • outpatient setting, through partial hospitalization programs (day-treatment), or in residential tx settings -majority managed with outpatient therapy" "Anorexia: What Therapists and Parents Need to Know - CORRECT ANSWER -Family Based Treatment (FBT) • Most successful therapy is based on parents helping their child • Twice as effective for recovery than ind. therapy • a quarter of the incidence of relapse *If you have an adolescent with anorexia nervosa who is medically stable, Family Based Treatment should be the first line tx" "Family-Based Treatment for Eating Disorders - CORRECT ANSWER -one of the most successful treatments for eating disorders in children and teens with anorexia nervosa, bulimia nervosa, and other specified feeding or eating disorder (OSFED) -sometimes called "Maudsley Family Therapy," (development at Maudsley Hospital in London) -involves the whole family in solving their child's eating disorder -does not blame the family -prescribes family sessions with a therapist at first once a week, decreasing over the course of tx • typically at least one family meal at beginning of tx in therapist's office" "Bulimia Nervosa and BED Tx - CORRECT ANSWER -combining antidepressant meds with psychotherapy • AVOID BUPROPION risk of seizures with active symptoms of bulimia nervosa -Lisdexamfetamine approved for moderate to severe BED in adults -no med FDA approved for children/adolescents with BED -CBT for bulimia nervosa and BED -Brief strategic therapy pharmacological tx for bulimia nervosa -1st line • fluoxetine -2nd Line • sertraline • escitalopram • fluvoxamine -3rd Line • tricyclic antidepressants • trazodone • MAOIs • topiramate" "Pica Tx - CORRECT ANSWER -no gold standard tx -primarily behavioral tx's • noncontingent reinforcement, environmental enrichment, and overcorrection -Pharmacological interventions, typically not used, only address co-morbid conditions -surgical interventions when obstructions or perforations occur -No interventions proven efficacious for long-term tx" "ARFID Tx - CORRECT ANSWER -limited literature about tx & no med is specifically indicated for use in this disorder -once medically stable • family-based therapy adapted specifically for clients with ARFID has demonstrated effectiveness" "Gender identity - CORRECT ANSWER One's concept of oneself as male, female, a blend of both, or neither derived from an interaction of biological traits, developmental influences, & environmental conditions. -Transgender -Nonbinary -Cisgender -Agender" "Gender expression - CORRECT ANSWER -external appearance or performance of one's gender. -may include clothing, behavior, other characteristics. -may be associated with masculine traits, feminine traits, both, or neither -may or may not conform to socially defined gender behaviors -does not necessarily reflect gender identity. • Feminine • Masculine • Androgynous • Gender-neutral • Gender non-conforming" "Sexual orientation - CORRECT ANSWER -Enduring emotional, romantic, or sexual attraction to others • Heterosexual/straight • Homosexual/gay/lesbian • Bisexual • Pansexual • Asexual" "Assigned sex - CORRECT ANSWER -Sex assigned to an infant at birth -based on visible sex organs & other physical characteristics • Male • Female • Intersex" "Children begin to become aware of the physical differences between boys and girls at approximately __________ of age - CORRECT ANSWER 2 years of age -By 4 most have an established gender identity" "Diagnosing Gender Dysphoria - CORRECT ANSWER -when a person experiences clinically significant discomfort or distress from the misalignment of their gender identity & their assigned sex -often begin in childhood • may not experience symptoms until puberty or later -Dx criteria different for adolescents & adults -All ages: must experience significant distress or impairment in social, occupational, or other areas of functioning as a result of symptoms -dx typically req to receive gender-affirming care, including hormone therapy or surgical intervention" "consequences frequently experienced by transgender persons - CORRECT ANSWER -80% trans students feel unsafe at school because of their gender expression -58.7% of gender non-conforming students have experienced verbal harassment in the past year because of their gender expression • compared to 29% of their peers -49% of trans ppl reported physical abuse (2007 survey) -50% of trans ppl have been raped or assaulted by a romantic partner -Trans people of color are 6x more likely to experience physical violence when interacting with police than white cisgender survivors of violence -41% of trans ppl have attempted suicide -1/5 trans ppl have experienced homelessness at some point -1/8 have been evicted due to being trans" "Treatment for clients with gender dysphoria - CORRECT ANSWER -highly individualized -supportive care environment that allows for the exploration of gender identity & expression is essential -Gender-Affirming Psychotherapy -Parental & Sibling coaching -Individual therapy" "Why support for trans youth matters - CORRECT ANSWER -Trans Youth with Supportive Parents • 77% reported life satisfaction; 33% reported dissatisfaction • 70% described mental health as very good or excellent; 15% described their mental health as poor • 23% report suffering depression; 75% report not suffering depression -Trans Youth with Unsupportive Parents • 64% reported low self-esteem; 13% reported high self-esteem • 0% faced no housing problems; 55% faced housing problems. • 4% did not attempt suicide; 57% attempted suicide" "Some clients will share information about their sexuality or gender identity with providers that they have not yet shared with parents or guardians; ____________ of these disclosures must be ____________. - CORRECT ANSWER confidentiality, maintained." "The Trevor Project - CORRECT ANSWER -leading suicide prevention & crisis intervention nonprofit organization for LGBTQ young people. -provide information & support to LGBTQ young people 24/7, all year round." "It Gets Better Project - CORRECT ANSWER -mission is to uplift, empower, and connect lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth around the globe." "Parents and Friends of Lesbians and Gays (PFLAG) - CORRECT ANSWER -creating a caring, just, and affirming world for LGBTQ+ people and those who love them. -support and resources" "Family Acceptance Project - CORRECT ANSWER -research, intervention, education & policy initiative to prevent health & mental health risks & to promote well-being for lesbian, gay, bisexual, transgender and queer-identified (LGBTQ) children & youth • including suicide, homelessness, drug use and HIV • in the context of their families, cultures & faith communities" "LGBTQ+ Health Disparities and Providing Equitable Care - CORRECT ANSWER -Provider awareness, recognizing personal biases, and community outreach are all important steps in eliminating healthcare disparities for the LGBTQ+ community -provide support and acceptance to all clients -establish a non-discrimination policy • language about sexual orientation, gender identity, & gender expression. -create an open office environment • using inclusive language • both chosen name & legal name on assessment forms, blank space for gender • spaces in EMR & paper forms to allow pts to identify appropriately -pediatric pt, have boxes for "Parent 1 & Parent 2" instead of "mother" & "father". -non-gendered bathrooms -educational materials with health information relevant to LGBTQ+ clients -posters that display racial, ethnic, and sexual diversity -provider and staff training" "Substance Use Disorders in Adolescents - CORRECT ANSWER -Substance use often begins in adolescence • when 1st signs of other mental illnesses commonly appear -Much of brain development occurs in adolescence -Executive functioning & impulse control tend to occur in late adolescence-early adulthood • vulnerable to substance use & development of a SUD -By adulthood, 50% have tried illicit substance, >80% used alcohol -alcohol, marijuana, tobacco are substances adolescents used most freq." "Annual Prevalence of Use of Various Drugs for Grades, 8, 10, and 12 Combined: - CORRECT ANSWER 38.3% will use alcohol 24.6% will use marijuana 27.1% will vape or smoke cigarettes 9.2% will use illicit drugs other than marijuana" "Diagnosing SUDs in Adolescents - CORRECT ANSWER -recurrent use of a substance, such as alcohol or drugs, causes clinically significant impairment • health problems, disability, or failure to meet responsibilities at home, work, or school -not all who experiment with substances will meet criteria SUD -adolescents may experience (-) social & health consequences • can affect growth & development of the brain & increase freq of risky behaviors" "Early drug use is a risk factor for: - CORRECT ANSWER later development of a SUD & other mental health conditions" "SUDs Common Comorbidities - CORRECT ANSWER -other mental health conditions • Anxiety disorders • Depression • Bipolar disorder • Psychotic illness • Borderline personality disorder • Antisocial personality disorder" "Individuals with untreated _______ are at particular risk for developing a SUD - CORRECT ANSWER ADHD" "Adolescent substance use Screening - CORRECT ANSWER -American Academy of Pediatrics (AAP) recommended universally screening all adolescents for substance use during routine healthcare visits • using a Substance Use Screening, Brief Intervention, & Referral (SBIRT) approach -commonly used SBIRT tool is the CRAFFT screening tool • recommended by the AAP Bright Futures Guidelines for preventative care screenings." "CRAFFT tool - CORRECT ANSWER • C: Have you ever ridden in a Car driven by someone, including yourself, who was "high" or had been using alcohol or drugs • R: Do you ever use alcohol or drugs to Relax, feel better about yourself or fit in? • A: Do you ever use alcohol or drugs while you are by yourself (Alone)? • F: Do you ever Forget things that you did while using alcohol or drugs? • F: Do your Family or Friends ever tell you that you should cut down on your drinking or drug use? • T: Have you ever gotten into Trouble while you were using alcohol or drugs? *2+ yes answers suggest a significant problem" "SUD screening tools to use with adolescents 12-18 years - CORRECT ANSWER -Screening to Brief Intervention (S2BI) -Brief Screener for Tobacco, Alcohol, and other drugs (BSTAD)" "Drug testing - CORRECT ANSWER -AAP supports the use of drug testing in: • emergencies • on a voluntary basis as part of a full assessment of behavioral or mental health symptoms • as part of therapy or monitoring of a client with an identified substance use disorder -the use of "suspicionless" drug testing as a means of screening for drug use is not useful for both practical & ethical reasons -parents may request that a provider drug test their child • AAP cautions against the use of involuntary drug testing on a mentally competent adolescent" "AAPs position on drug testing at home and in schools - CORRECT ANSWER video" "Adolescent SUDs Tx - CORRECT ANSWER -Behavioral treatments • most prevalent interventions for adolescent SUDs • CBT, group therapy, contingency management, motivational interviewing -12-step programs or peer-to-peer programs -Residential treatment • clients who require stabilization, present a danger to themselves or their families, or present a public safety risk -family involvement is often integral • tx plan may include family therapy -Multidimensional Family Therapy • may be an alternative to residential tx for substance use & co-occurring mental health disorders -Medication-assisted treatment (MAT) is less likely to be used with adolescent clients -Community Reinforcement and Family Training (CRAFT) tx strategy • increase motivation & communication skills within a family impacted by addiction" "Adverse childhood experiences (ACEs) - CORRECT ANSWER traumatic events that occur before a child reaches age 18 -Growing up in a family with mental health or substance use problems can also cause traumatic injury -ACEs, stressful or traumatic experiences • sexual or domestic violence, physical or emotional abuse, or neglect • home environment that cause them to feel unsafe or under constant threat • situations that create instability death, divorce, separation, or incarceration of family members" "___ in ___ adults have experienced four or more types of ACEs - CORRECT ANSWER one in six" "Trauma- and Stressor-Related Disorders - CORRECT ANSWER Post-traumatic stress disorder Acute stress disorder Adjustment disorders Reactive attachment disorder Prolonged grief disorder" "freeze vs. shutdown trauma responses - CORRECT ANSWER -Freeze • client is HYPERaroused. • muscles are tense, full of energy, but can't release it. • similar levels of sympathetic & parasympathetic activation. • Increased heart rate/BP. • pt might say, "I feel stuck," "I can't move," or "I feel like I am encased in cement." • Eyes widen. • body is ready to return to fight/flight as soon as the threat passes. -Shutdown/Collapse • client is HYPOaroused. • muscles are flaccid & loose. • parasympathic nervous system is dominant. • Decreased heart rate/BP/temp. • pt may not be able to speak at all. • Blank stare. • Sensory info stops at the thalamus. It doesn't reach the cortex. pt less aware of their internal & external world. • Endorphins release to numb pain. Dynorphins release, which can make the client feel detached from their body. • Can result in fainting." "How Trauma Impacts Four Different Types of Memory: Semantic Memory - CORRECT ANSWER -What it is: memory of general knowledge & facts. -Explicit Memory -Example: You remember what a bicycle is. -How trauma can affect it: Trauma can prevent info (like words, images, sounds, etc.) from different parts of the brain from combining to make a semantic memory. -Related brain area: The temporal lobe and inferior parietal cortex collect information from different brain areas to create semantic memory." "How Trauma Impacts Four Different Types of Memory: Episodic Memory - CORRECT ANSWER -What it is: The autobiographical memory of an event of experience - including the who, what, and where. -Explicit Memory -Example: You remember who was there and what street you were on when you fell off your bicycle in front of a crowd. -How trauma can affect it: Trauma can shutdown episodic memory and fragment the sequence of events. -Related brain area: The hippocampus is responsible for creating and recalling episodic memory." "How Trauma Impacts Four Different Types of Memory: Emotional Memory - CORRECT ANSWER -What it is: The memory of the emotion you felt during an experience. -Implicit Memory -Example: When a wave of shame or anxiety grabs you the next time you see your bicycle after the big fall. -How trauma can affect it: After trauma, a person may get triggered and experience painful emotions, often without context. -Related brain area: The amygdala plays a key role in supporting memory for emotionally charged experiences." "How Trauma Impacts Four Different Types of Memory: Procedural Memory - CORRECT ANSWER -What it is: The memory of how to perform a common task without activtely thinking about it. -Implicit Memory -Example: You can ride a bicycle automatically without having to stop and recall how it's done. -How trauma can affect it: Trauma can change patterns of procedural memory. For example, a person might tense up and unconsciously alter their posture, which could lead to pain or even numbness. -Related brain area: The striatum is associated with producing procedural memory and creating new habits." "Four Key Ways Collapse/Submit response to trauma Can Present in a Client. - CORRECT ANSWER 1. Compliance / Obedience: -going through the motions of life on autopilot -feel detached from bodily experiences -feelings no longer guide their actions • Ex: domestic violence pt may no longer be aware of fear, which keeps the person in the situation. 2. Treatment-Resistant Depression: -ongoing, inescapable traumatic stress can lead to treatment-resistant depression. • defining feature: learned helplessness. 3. Interpersonal Conflict: -difficulty engaging with others &/or setting boundaries. 4. Social Avoidance / Desire to Isolate: C -difficult to engage in basic daily activities • making meals or personal hygiene -may withdraw socially." "Brain-based approaches to help clients after trauma - CORRECT ANSWER -Top-down approaches • Encourage different ways of thinking • Cognitive-Behavioral Therapy (CBT) • Dialectical-Behavior Therapy (DBT) • Mindfulness-based Cognitive Therapy (MBCT) -Bottom-up approaches • Ways to cope with emotions and defenses • Eye Movement Desensitization and Reprocessing (EMDR) • Yoga • Trauma Resiliency Model (TRM)®" "greater risk of experiencing four or more ACEs. - CORRECT ANSWER Females and racial/ethnic minority groups" "ACEs statistics - CORRECT ANSWER -almost half U.S. children (about 35 million) have had 1+ ACEs -over 1/4 of child abuse/neglect is children <3 • victimization most common for children under a year" "Tips when working with traumatized children - CORRECT ANSWER -establish a daily routine • predictability can be calming -concentrate on support -help build self-regulation • schedule regular brain breaks to help children stay focused -lead with empathy -provide encouragement -see what you can do to help • ask children directly what you can do to help them make it through the day." "Challenging behaviors that result from toxic stress: - CORRECT ANSWER -Suffer anxiety in unfamiliar situations -Difficult to soothe -Aggressive or impulsive -Prone to bedwetting -Become withdrawn -Tend to lose recently acquired skills" "The Adverse Childhood Experiences (ACE) Study - CORRECT ANSWER -assessing, retrospectively & prospectively, the long-term impact of abuse & household dysfunction during childhood on the following outcomes in adults: • disease risk factors & incidence, quality of life, health care utilization, & mortality. -Largest investigation between childhood adversities and adult wellbeing • conducted at a Kaiser Permanente Facility in California from -Study looked at 10 ACEs (3 categories) • Abuse • Neglect • Household Challenges" "ACE Pyramid - CORRECT ANSWER -represents the conceptual framework for the ACE study -top to bottom the pyramid shows the mechanisms by which ACEs influence health and well-being from conception to death • Early death (TOP) • Disease, disability, and social problems • Adoption of health risk behavior • Social, emotional, and cognitive impairment • Disrupted neurodevelopment • ACEs • Social conditions / Local context • Generational embodiment / Historical trauma (BOTTOM)" "ACE Risk Factors: Individual Risk Factors - CORRECT ANSWER • lack of closeness to parents/caregivers • Early sexual activity • Few or no friends • Friends who engage in aggressive or delinquent behavior" "ACE Risk Factors: Family Risk Factors - CORRECT ANSWER • Caregiving challenges related to children with disabilities, mental health issues, or chronic physical illnesses • limited understanding of children's needs or development • Caregivers who were abused or neglected as children • Young caregivers or single parents • Low income or low levels of education • High levels of parenting stress or economic stress • Isolation • High conflict & negative communication styles • Attitudes accepting of or justifying violence or aggression" "ACE Risk Factors: Community Risk Factors - CORRECT ANSWER • High rates of violence & crime • High rates of poverty & limited educational & economic opportunities • High unemployment rates • Easy access to drugs & alcohol • Few community activities for young people • Unstable housing & where residents move frequently • Food insecurity" "ACE Categories - CORRECT ANSWER -Abuse -Neglect -Household Instability -Cultural Challenges" "ACE: Abuse -Intimate Partner Violence (IPV) - CORRECT ANSWER -Intimate Partner Violence (IPV) • AKA domestic violence • ind harms or threatens to harm a current or past partner or spouse • controlling or coercive behavior or physical, sexual, verbal, financial, or emotional abuse • can include: stalking, terrorizing, blame, humiliation, manipulation, or intentional isolation from family and friends • Children may witness or be directly injured" "ACE: Abuse -Psychological Maltreatment (PM) - CORRECT ANSWER -Psychological Maltreatment (PM) • AKA emotional abuse • failure of a parent or caregiver to meet a child's psychological or emotional needs • attacks a child's sense of self, is demeaning or humiliating • acts of commission, such as verbal attacks, or acts of omission, such as emotional unresponsiveness • embedded in all other forms of child maltreatment" "ACE: Abuse -Physical Abuse - CORRECT ANSWER -Physical Abuse • parent or caregiver commits an act that causes physical injury to a child or adolescent • approx 10% of child maltreatment cases • may struggle with self-esteem or social relationships • may have trouble trusting authority figures • Some children develop stress reactions • may act out, become aggressive or develop behavior problems, while others may become anxious, numb, or withdrawn • Some lose typical fight-or-flight reactions, making them more susceptible to danger" "ACE: Abuse -Sexual Abuse & Sexual Violence - CORRECT ANSWER -Sexual Abuse & Sexual Violence • any interaction between a child and an adult or another child in which the child is used for the sexual gratification of the perpetrator or an observer • approx 7% of child maltreatment cases • may include touching and non-touching behaviors • long-term consequences for physical & mental health: increased risk for substance abuse, engagement in risky sexual behaviors, self-cutting or suicidal behavior, PTSD, depression, anxiety" "ACE: Neglect - CORRECT ANSWER -most common forms of child maltreatment • approx 60% of cases investigated by CPS -occurs when a parent/caregiver fails to provide for a child's age-appropriate needs • food, shelter, clothing, education, medical care, supervision, emotional needs -can result in long-lasting physical or psychological harm -often tied to poverty -may present with poor hygiene, inadequate weight gain, clothing that fits poorly/is inappropriate for weather -can disrupt healthy development" "ACE: Household Instability - CORRECT ANSWER -may be caused by: parental mental illness, stress, substance abuse, suicide, presence of violence toward the mother in the family -Children exposed to family instability may struggle socially, cognitively, or behaviorally. -instability from the loss of a parent or caregiver due to death, divorce, abandonment, or incarceration • 2022, >5.2 million children worldwide lost a parent/caregiver due to COVID" "ACE: Cultural Challenges - CORRECT ANSWER -Community Violence • exposure of a child to acts of interpersonal violence in a public setting by individuals not intimately connected to the child • Ex: shootings in public areas, fights, bullying, war or warlike conditions, terrorist attacks • often occurs suddenly, without warning -Bullying • AKA peer victimization • form of aggression or harassment • inflicts social, emotional, physical, or psychological harm on someone a perpetrator perceives to be less powerful • Cyberbullying: via text, email, or social media. -Racism and Structural Racism • assigning value and providing opportunity based on physical properties such as skin color • hate crimes, slurs, discrimination, marginalization, prejudice • major life stressor for Black youth" "Effects of Bullying - CORRECT ANSWER -Stress, anxiety, or depression -Traumatic stress reactions -Anger or frustration -Isolation or loneliness -Poor self-esteem or self-image -School avoidance or poor school performance -Separation anxiety -Health complaints -Self-injury -Eating disorders -Suicidal or homicidal ideations or actions" "Consequences of ACEs - CORRECT ANSWER Untreated, short- & long-term health outcomes -immediate physical danger -cumulative & prolonged stress -Toxic stress can disrupt brain development • negative forms of stress • cortisol produced -stress response system constantly activated and other neuropathways not getting as much energy -Parts of the brain that might be weakened, those regulating complex functions like: • emotional self-regulation • social interactions • abstract thinking -social, behavioral, and cognitive challenges -Risk for: Major depression, suicidality, anger management, high risk behavior, adult criminality" "Exposure to ACEs increases the risk for: - CORRECT ANSWER autoimmune disorders, arthritis, type 2 diabetes, cancer, and mental illness" "how childhood trauma affects adult relationships - CORRECT ANSWER -Wounded Child: Was wounded by abuse or neglect • A young, vulnerable, possibly pre-verbal child • Often overwhelmed, yet longs for connection • Much trauma work focuses on the wounded child • But it's NOT usually the wounded child that brings dysfunction into adult relationships -Adaptive Child: A child's version of an adult that developed to protect the wounded child • Often a perfectionist, harsh and unforgiving • Sees the world in black and white • An older child • Unable to learn skills • Cares only about self-preservation • Views intimacy as a threat • Not only reacts to aggressor, but also identifies with aggressor" "Interventions for ACEs and Toxic Stress - CORRECT ANSWER -support to prevent lifelong consequences -work with parents & children to teach stress-reduction techniques to enhance (+) coping skills -Parent training • help caregivers learn healthy, alternative ways to manage child behaviors -Early childhood programs • provide protective factors, support (+) development in young children -Factors That Promote Resilience • Close relationships with skilled caregivers or other caring adults • Caregiver knowledge & use of (+) parenting skills • Having a sense of purpose (faith, culture, identity) • Individual competencies (problem-solving skills, self-regulation, autonomy) • Opportunities to connect socially • Access to support services for parents & families • Community support resources" "5 strategies to stop ACEs before they start - CORRECT ANSWER 1. Strengthening economic supports for families 2. Changing social norms 3. Quality child care & education early in life 4. Enhancing parenting skills 5. Intervening to lessen harms & prevent future risk" "_______, ________, _________ _____________ and ______________ are essential to prevent child abuse and neglect and to assure that all kids reach their full potential - CORRECT ANSWER Safe, stable, nurturing relationships and environments" "Trauma-Informed Care - CORRECT ANSWER -essential for caring for clients who have experienced adversity -Substance Abuse and Mental Health Services Administration ID'd 6 guiding principles: • Safety • Trust and Transparency • Peer Support • Collaboration • Empowerment & Choice • Cultural, Historical, & Gender Awareness" "At risk for PTSD - CORRECT ANSWER -Prior trauma -Adverse childhood experiences -Personal or family history of psychiatric disorders -Female gender -Severe trauma exposure" "consequences of PTSD - CORRECT ANSWER -social, occupational, & physical impairment -physical health problems -reduced quality of life -increased risk of suicide -more likely to present with comorbidities: • MDD • anxiety disorder • substance use disorder" "DSM-5-TR trauma- and stressor-related diagnoses: PTSD - CORRECT ANSWER -client may have experienced the event personally or may have been a witness to the event • source of the exposure must not be through media, including movies, television, or the internet -Symptoms typically begin within the first 3 months after the traumatic event occurred, and the client must have symptoms for at least 1 month to be diagnosed -Intrusion symptoms • Recurrent, intrusive memories of the trauma; children may engage in repetitive play expressing themes of the trauma. • Distressing dreams or nightmares • Dissociative reactions, or flashbacks • Intense psychological distress or physiological reactions when exposed to cues that symbolize or represent an aspect of the trauma -Avoidance symptoms • Avoidance of distressing memories, thoughts, or feelings • Avoidance of reminders, including people, places, situations, of the traumatic event -Negative cognitive or mood symptoms • Memory deficits surrounding the traumatic event • Exaggerated negative beliefs of self or environment • Distorted cognitions and self-blaming behaviors r/t the cause or consequences of trauma • Persistent (-) emotions, including anger, guilt, fear, or shame • Feelings of detachment from others • Persistent inability to experience (+) emotions • Social withdrawal in children under the age of 6 -Arousal or reactivity symptoms • Irritability & verbal or physical aggression • Reckless or risk-taking behaviors • Hypervigilance • Concentration difficulty • Exaggerated startle response • Sleep disturbances" "ways early life trauma can effect people later in life - CORRECT ANSWER Problems with emotional awareness Emotion dysregulation Social functioning" "Screening instruments for children to assist with the diagnosis of trauma. - CORRECT ANSWER selected based on the age of the child -child under the age of 6, a parent or caregiver completes the tool • Child and Adolescent Trauma Screen-Caregiver (CATS-C) - 3-6 Years -children ages 7-17, both child & parent may complete the screening. • Child and Adolescent Trauma Screen (CATS) - 7-17 Years" "children and adolescents with PTSD tx - CORRECT ANSWER -trauma-focused cognitive behavior therapy (TF-CBT) -eye movement desensitization and reprocessing (EMDR) -narrative exposure therapy -classroom-based interventions *Therapy may be individual or group-based *Parental involvement is important to help establish family resilience" "DSM-5-TR trauma- and stressor-related diagnoses: Acute Stress Disorder - CORRECT ANSWER -To be diagnosed, client must present with nine symptoms of intrusion, negative mood, dissociation, avoidance, or arousal beginning or worsening after the traumatic event occurred. -differentiated from PTSD based on the timeframe in which the symptoms occur • acute stress disorder: symptoms that last from 3 days to 1 month immediately following exposure to the traumatic event -may experience catastrophic thoughts, panic attacks, separation anxiety & guilt r/t the event -Post-concussive symptoms: headaches, sensitivity to light, difficulty concentrating, irritability, dizziness, are common, even though a head injury may not have occurred" "Dissociative symptoms are common in both _______________ and ___________ - CORRECT ANSWER acute stress disorder and PTSD -may include: • depersonalization (feelings of detachment from one's own body) • derealization (feelings that one's surroundings are not reality)" "Cherie is a 5-year-old whose uncle was killed in a drive-by shooting last week. Cherie has heard her mother and aunt talking about the murder in detail. For the past three nights, Cherie has woken from nightmares; she is not able to describe details from her dreams. Cherie's mother describes her as "jumpier" than usual since they learned of the event and she is concerned because she saw Cherie reenact a drive-by shooting while playing with her Barbie dolls. Does Cherie meet the diagnostic criteria for acute stress disorder? yes no - CORRECT ANSWER no Rationale: Although Cherie presents with several symptoms that may be associated with acute stress disorder, she does not currently meet diagnostic criteria. Cherie has been exposed to the violent death of a loved one and is experiencing intrusion symptoms including nightmares and distressing memories of the event as evidenced by themes of the event used in play. Her mother has also noticed an exaggerated startle response. To be diagnosed with acute stress disorder, a client must present with nine symptoms of intrusion, negative mood, dissociation, avoidance, or arousal beginning or worsening after the traumatic event occurred." "DSM-5-TR trauma- and stressor-related diagnoses: Adjustment Disorder - CORRECT ANSWER -development of emotional or behavioral symptoms within 3 months of the onset of a new stressor -Symptoms cause significant impairment in social or occupational functioning but do not persist past 6 months after the initial stressor has resolved -Persistent adjustment disorder may occur when stressors have no clear resolution • physical disability or living in a community with high crime rates -classified using specifiers with: • depressed mood • anxiety • mixed anxiety & depressed mood • disturbance of conduct • mixed disturbance of emotions & conduct" "DSM-5-TR trauma- and stressor-related diagnoses: Reactive Attachment Disorder (RAD) - CORRECT ANSWER -rare, occurs when a child fails to form an emotional bond with caregivers -commonly caused by abandonment, severe neglect, or maltreatment -difficulty forming emotional attachments to others -decreased ability to experience (+) emotions -unable to seek or accept physical or emotional closeness -can react violently to attempts to hold or cuddle them -Behavior & moods can be unpredictable • some children appearing to live in a constant state of fight, flight, or freeze mode -often difficult to discipline or console -Parent education and support are critical" "DSM-5-TR trauma- and stressor-related diagnoses: Prolonged Grief Disorder - CORRECT ANSWER -persistent, maladaptive grief that causes significant impairment in social, occupational, or other areas of functioning -Symptoms persist for at least one year following the death of a loved one in adults and 6 months in children & adolescents • disbelief surrounding the death • avoidance of reminders that their loved one is dead • intense emotional pain or numbness • difficulty engaging with friends or interests • loneliness • sense of meaninglessness -Children may express their distress through: • play, behavior changes, regression, and separation anxiety, excessive worry about their health, questions about death -Adolescents may endorse feelings of "giving up" on hopes and aspirations due to the death of their loved ones" "Consequences of prolonged grief: - CORRECT ANSWER -increased substance use -increased risk for cardiovascular disease -increased risk of dropping out of school" "Clients who experience prolonged grief disorder may benefit from: - CORRECT ANSWER referral to a grief specialist and bereavement support groups" "Brief Grief Questionnaire - CORRECT ANSWER -aid in the diagnosis of prolonged grief disorder • How much are you having trouble accepting the death of ______________? • How much does your grief still interfere with your life? • How much are you having images or thoughts of _____________ when s/he died or other thoughts about the death that really bother you? • Are there things you used to do when ______ was alive that you don't feel comfortable doing anymore, or that you avoid? How much are you avoiding these things? -All questions answered with: Not at all: 0 Somewhat: 1 A lot: 2 -score of 4+ suggests ind may have complicated grief • Refer to grief specialist for further eval" "Rochelle is a 16-year-old high school junior who presents with her mother for an initial consult with the PMHNP. Two months ago, another high school student brought a gun to school and shot eight students and two teachers. Three victims died. Rochelle did not know any of the victims personally. Since the shooting, Rochelle has frequently been tearful, and she is angry at times. She and her classmates have been attending school virtually, but Rochelle has had difficulty with concentration and often skips classes. and she told her mother she will "never go back to that building again." Rochelle has also told her mother that she feels guilty for "making it out alive" and that life does not seem worth living any longer. Her mother reports that Rochelle, once a happy child, does not seem capable of happiness any longer, and she has started to stay out all night with friends; when she comes home in the morning, her - CORRECT ANSWER PTSD Rationale: Rochelle meets the diagnostic criteria for PTSD. She has been involved in a traumatic event and has experienced recurrent memories of the event. Avoidance symptoms: she avoids external reminders of the trauma by refusing to go to the school building where the trauma occurred. Negative cognition/mood symptoms: she experiences a persistent negative emotional state as evidenced by crying, anger, and guilt. She is unable to experience positive emotions such as happiness. Arousal symptoms: she has difficulty concentrating and has engaged in risk-taking behaviors that were not present before the trauma. Her symptoms have lasted over a month, which rules out a diagnosis of acute stress disorder." "Which of the following is the priority intervention for Rochelle? trauma-focused cognitive behavior therapy complete a suicide screening start sertraline 50 mg daily family-based therapy - CORRECT ANSWER complete a suicide screening Rationale: Rochelle has expressed that life does not seem worth living. She is also experiencing survivor guilt which increases the risk of suicide. Although trauma-based therapy is essential to recovery, the client's immediate safety is the priority." "Pediatric Mental Health Crisis - CORRECT ANSWER -when a child is at risk of harm to self or others or if behaviors & emotions seem extreme or out of control -may occur due to mental health diagnoses, substance use, medical condition -may require emergency intervention or inpatient tx" "!!!!!!!!!Warning signs of a pediatric mental health crisis!!!!!!!! - CORRECT ANSWER -expressing suicidal thoughts -threatening harm to self or others -engaging in self-harm such as cutting -displaying severe agitation or aggression -experiencing hallucinations or delusions -isolating from family & friends *If child or those close to them are in immediate danger of harm, safety is the priority. PMHNP should instruct parent/caregiver to contact 911 or go to the nearest emergency room" "Crisis resources for families - CORRECT ANSWER -Crisis Text Line • text HOME to 741741 (volunteer crisis counselor) -State crisis hotlines • Michigan, Third Level Crisis Center, -NAMI Navigating a Mental Health Crisis guide • "Suicide - CORRECT ANSWER -2nd leading cause of death for people age 10 to 24 -younger children, suicide is often an impulsive act • associated with feelings of sadness, anger, confusion, or problems with attention & hyperactivity -teenagers, suicide attempts may stem from feelings of stress, insecurity, pressure to succeed, disappointment, or loss" "Risk factors in youth suicide - CORRECT ANSWER -Hx of substance abuse -Physical disability or illness -Losing a friend or family member to suicide -Ongoing exposure to bullying behavior -Mental health condition -Recent death of a family member or a close friend -Access to harmful means -Relationship problems -Previous suicide attempts" "Protective factors in youth suicide - CORRECT ANSWER -Connections to other non-parental adults -School safety -Closeness to caring friends -Overall resilience -Neighborhood safety -Awareness of & access to local health services -Academic achievement -Parent connectedness" "!!!!!!!!Warning signs for suicide include:!!!!!!!!! - CORRECT ANSWER -openly suicidal statements or comments such as "I wish I was dead," or "I won't be your problem much longer." -changes in eating or sleeping patterns -frequent or pervasive sadness -complaints about emotion-related physical symptoms such as headaches or stomachaches -worsening school performance -preoccupation with death & dying" "suicides in children and adolescents - CORRECT ANSWER -vast majority occur in the family home (95.5%) -most common cause, suicide by hanging (78.4%) -firearms are used in many cases (18.7%) -Education & support for children, adolescents, & their families in suicide prevention, identification of warning signs, & appropriate responses are essential • safely securing firearms and high-risk medication and being aware of materials that could be used for hanging or suffocation -National Suicide Prevention Hotline • 988 Suicide & Crisis Lifeline" "Health Promotion - CORRECT ANSWER -Physical Activity •