NR 606 Midterm Exam Study Guide | 2025 New Update | 100% Accurate.
Ethical and Practical Considerations – Week One
● What are barriers to seeking mental health care: parents lack of education or access to
services, parents reluctant to seek help due to the stigma or negative perceptions towards
mental health, Although some children and adolescents receive treatment, many drop out
before receiving effective treatment, often due to poverty, language barriers, living in
communities with scarce resources, and stressors such as problems in the family, violence
in the community, unstable housing, unemployment, and food insecurity. Cost, scheduling
conflicts, long waitlists for services, and high staff turnover also create impediments for
families seeking care.
● Social determinants and access to care in children and adolescents often due to poverty,
language barriers, living in communities with scarce resources, and stressors such as
problems in the family, violence in the community, unstable housing, unemployment, and
food insecurity. Cost, scheduling conflicts, long waitlists for services, and high staff turnover
also create impediments for families seeking care.
● Developmentally appropriate teaching in children and adolescents
● Racial and ethnic barriers to treatment
● Know types of stigma:
1) Structural: Structural stigma, or institutional stigma, includes policies, regulations, or
laws that intentionally or unintentionally lead to discrimination. Structural stigma can limit
access to resources and other opportunities, thereby impacting the well-being of the
stigmatized group. A program policy that prohibits individuals from using specific forms
of prescribed medication for addiction (MAT) treatment is an example of structural
stigma.
, 2) Self: self-stigma refers to the shame individuals internalize about negative stereotypes. For
individuals affected by SUDs, self-stigma may lead to feelings of being flawed or
unworthy of love or connection. It may also prevent them from seeking help.
3) Public: Public stigma encompasses the attitudes, beliefs, and behaviors of groups or
individuals which form a stereotype that creates an emotional reaction or prejudice and
results in discrimination. A stereotypic belief that individuals choose to use alcohol or
other drugs and blame them for their substance use disorder is an example of public
stigma. Healthcare providers who have a conscious or unconscious bias against clients
who use substances in the perinatal period may not provide appropriate care and treatment
4) Intervention: Madden (2019) has proposed a new category of stigma: intervention
stigma; “Individuals working in [medication-assisted treatment] MAT experience
discrimination and prejudice from other healthcare professionals, especially abstinent
treatment professionals who disagree with the use of medications to treat opioid use
disorders. This discrimination and prejudice stem at times from stigma toward
addiction diagnoses, and at other times toward unique features of MAT itself.
● Parental access to child/adolescent’s mental health records – legal aspects: Typically,
parents have the right to request access to a minor child’s mental health record, including
symptoms, diagnosis, and treatment plan; however, certain circumstances may limit that right.
The U.S. Department of Health and Human Services provides guidance regarding how the
Health Insurance Portability and Accountability Act (HIPAA) affects parents’ access to their
child’s information. State regulations may also address access to this information. PMHNPs
are responsible for following all relevant statutes in their state of practice. Can withhold if
suspect parental neglect?
● Ethical and legal principles of informed consent: Assess client ability to understand medical
information and treatment options and to make a voluntary decision. Present relevant
, information with accuracy and sensitivity. Should include information about diagnosis, nature
and purpose of treatment options, benefits, risks, and burdens of all treatment options,
including forgoing treatment. Document informed consent conversation in the medical record,
including all consent forms. Although children may not be able to give legal consent, they
should be included in discussions about medication and treatment whenever possible. Child
input into treatment decisions may encourage treatment adherence. Positive experiences with
providers and treatment can help instill the perception that treatment is beneficial, which can
support positive mental health behaviors in the future.
● Mandatory reporting: The Federal Child Abuse Prevention and Treatment Act (CAPTA)
requires each State to have provisions or procedures for requiring certain individuals to report
known or suspected instances of child abuse and neglect. Most states consider PMHNPs to be
mandated reporters who are required to report suspicions about abuse or neglect to the
appropriate authorities. Both federal and state statutes include stipulations related to
mandatory reporting. PMHNPs are responsible for following all relevant statutes in their state
of practice.
● What are principles of dosing children with medications/ physiologic differences in
treatment of children: Children have a more rapid metabolism than adults and may require
a larger dose of medication per unit of body weight. Around puberty, pharmacokinetic
properties reach adult parameters; therefore, dosing after puberty may need to be
decreased
● Piaget proposed four major stages of cognitive development, and called them (1)
sensorimotor intelligence (0-2), (2) preoperational thinking (2-7), (3) concrete
operational thinking (7-11) its like a car and meds will help it run better, and (4)
formal operational thinking (12 and up).
● Roughly 50% of lifetime cases of mental illness begin by age 14
, ● A challenge to prescribing psychoactive medications in the perinatal period is the
paucity of evidence regarding the true risks for the pregnant client and developing
fetus. Evidence obtained from controlled clinical trials is limited as pregnant women
and newborns are considered vulnerable subjects.
● Selective serotonin reuptake inhibitors (SSRIs) are first-line treatments for
depression and anxiety during pregnancy. Selective norepinephrine reuptake
inhibitors (SNRIs), tricyclic antidepressants, and bupropion are also considered safe
treatment options
● Social determinants of health also impact the risk for maternal mental health disorders.
Individuals with low monthly income, lower education levels, or unemployed status,
have higher rates of psychiatric illnesses, as do childbearing people who are
unpartnered
Ethical and Practical Considerations – Week One
● What are barriers to seeking mental health care: parents lack of education or access to
services, parents reluctant to seek help due to the stigma or negative perceptions towards
mental health, Although some children and adolescents receive treatment, many drop out
before receiving effective treatment, often due to poverty, language barriers, living in
communities with scarce resources, and stressors such as problems in the family, violence
in the community, unstable housing, unemployment, and food insecurity. Cost, scheduling
conflicts, long waitlists for services, and high staff turnover also create impediments for
families seeking care.
● Social determinants and access to care in children and adolescents often due to poverty,
language barriers, living in communities with scarce resources, and stressors such as
problems in the family, violence in the community, unstable housing, unemployment, and
food insecurity. Cost, scheduling conflicts, long waitlists for services, and high staff turnover
also create impediments for families seeking care.
● Developmentally appropriate teaching in children and adolescents
● Racial and ethnic barriers to treatment
● Know types of stigma:
1) Structural: Structural stigma, or institutional stigma, includes policies, regulations, or
laws that intentionally or unintentionally lead to discrimination. Structural stigma can limit
access to resources and other opportunities, thereby impacting the well-being of the
stigmatized group. A program policy that prohibits individuals from using specific forms
of prescribed medication for addiction (MAT) treatment is an example of structural
stigma.
, 2) Self: self-stigma refers to the shame individuals internalize about negative stereotypes. For
individuals affected by SUDs, self-stigma may lead to feelings of being flawed or
unworthy of love or connection. It may also prevent them from seeking help.
3) Public: Public stigma encompasses the attitudes, beliefs, and behaviors of groups or
individuals which form a stereotype that creates an emotional reaction or prejudice and
results in discrimination. A stereotypic belief that individuals choose to use alcohol or
other drugs and blame them for their substance use disorder is an example of public
stigma. Healthcare providers who have a conscious or unconscious bias against clients
who use substances in the perinatal period may not provide appropriate care and treatment
4) Intervention: Madden (2019) has proposed a new category of stigma: intervention
stigma; “Individuals working in [medication-assisted treatment] MAT experience
discrimination and prejudice from other healthcare professionals, especially abstinent
treatment professionals who disagree with the use of medications to treat opioid use
disorders. This discrimination and prejudice stem at times from stigma toward
addiction diagnoses, and at other times toward unique features of MAT itself.
● Parental access to child/adolescent’s mental health records – legal aspects: Typically,
parents have the right to request access to a minor child’s mental health record, including
symptoms, diagnosis, and treatment plan; however, certain circumstances may limit that right.
The U.S. Department of Health and Human Services provides guidance regarding how the
Health Insurance Portability and Accountability Act (HIPAA) affects parents’ access to their
child’s information. State regulations may also address access to this information. PMHNPs
are responsible for following all relevant statutes in their state of practice. Can withhold if
suspect parental neglect?
● Ethical and legal principles of informed consent: Assess client ability to understand medical
information and treatment options and to make a voluntary decision. Present relevant
, information with accuracy and sensitivity. Should include information about diagnosis, nature
and purpose of treatment options, benefits, risks, and burdens of all treatment options,
including forgoing treatment. Document informed consent conversation in the medical record,
including all consent forms. Although children may not be able to give legal consent, they
should be included in discussions about medication and treatment whenever possible. Child
input into treatment decisions may encourage treatment adherence. Positive experiences with
providers and treatment can help instill the perception that treatment is beneficial, which can
support positive mental health behaviors in the future.
● Mandatory reporting: The Federal Child Abuse Prevention and Treatment Act (CAPTA)
requires each State to have provisions or procedures for requiring certain individuals to report
known or suspected instances of child abuse and neglect. Most states consider PMHNPs to be
mandated reporters who are required to report suspicions about abuse or neglect to the
appropriate authorities. Both federal and state statutes include stipulations related to
mandatory reporting. PMHNPs are responsible for following all relevant statutes in their state
of practice.
● What are principles of dosing children with medications/ physiologic differences in
treatment of children: Children have a more rapid metabolism than adults and may require
a larger dose of medication per unit of body weight. Around puberty, pharmacokinetic
properties reach adult parameters; therefore, dosing after puberty may need to be
decreased
● Piaget proposed four major stages of cognitive development, and called them (1)
sensorimotor intelligence (0-2), (2) preoperational thinking (2-7), (3) concrete
operational thinking (7-11) its like a car and meds will help it run better, and (4)
formal operational thinking (12 and up).
● Roughly 50% of lifetime cases of mental illness begin by age 14
, ● A challenge to prescribing psychoactive medications in the perinatal period is the
paucity of evidence regarding the true risks for the pregnant client and developing
fetus. Evidence obtained from controlled clinical trials is limited as pregnant women
and newborns are considered vulnerable subjects.
● Selective serotonin reuptake inhibitors (SSRIs) are first-line treatments for
depression and anxiety during pregnancy. Selective norepinephrine reuptake
inhibitors (SNRIs), tricyclic antidepressants, and bupropion are also considered safe
treatment options
● Social determinants of health also impact the risk for maternal mental health disorders.
Individuals with low monthly income, lower education levels, or unemployed status,
have higher rates of psychiatric illnesses, as do childbearing people who are
unpartnered
