NURS 6660N MIDTERM EXAM 1 QUESTION AND ANSWERS. A PASS QUARANTEED

NURS 6660N MIDTERM EXAM 1 – QUESTION AND ANSWERS 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 C 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 B 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; Jason’s pediatrician felt that the complaint warranted an evaluation by child psychiatry. 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 D 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 A 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) B Which of the following behaviors is least suspicious for an adolescent who is being bullied at school? A. A significant change in study habits in which the patient is demonstrating higher academic achievement to the exclusion of a social life B. A persistent, sustained increase in the number and variety of physical complaints that have no obvious organic cause C. Evidence that the patient has started smoking cigarettes and seems to spend more time alone than usual D. Migration to a completely different peer group and a change in appearance and behavior to aggressively mimic the new group A Michael is a 13-year-old boy who was involved in a traumatic automobile accident in which his mother, the driver, was killed. After suffering multiple injuries and weeks in the hospital, Michael was discharged to home with physical therapy. He ultimately made a complete physical recovery but is unable to get into a car. Just the thought of riding in a car produces profound physiologic symptoms. He has been diagnosed with post-traumatic stress disorder (PTSD). His avoidance of riding in a car is conceptualized as: A. Panic attacks B. Operant conditioning C. Hyper arousal D. Flashbacks C Which of the following is a true statement with respect to developmental testing in infants? A. None of the available validated developmental tools are reliable in infants under 6 months of age. B. An infant’s score on developmental assessment is a reliable predictor of future intelligence quotient. C. Infant assessments are helpful in detecting mental retardation and developmental disorders. D. Assessment in older infants focuses on sensorimotor and social responses. C Wendy is a 6-year-old female being evaluated by the PMHNP following a suicide attempt. The police were called when a neighbor saw Wendy jump out of the open window of her first-floor apartment. She was unhurt, but when the neighbor asked why she jumped out she said she wanted to kill herself. Which coincident finding would warrant an inpatient psychiatric admission for Wendy? A. This was not the first episode. B. The caretaker is incapable of arranging follow-up. C. One or both of the biological parents has a history of suicide attempts. D. Wendy was left with a babysitter when the incident occurred. B Caleb is a 10-year-old boy who is referred for assessment because he is not following any of the rules of discipline at home. His parents report that they have had three separate nannies resign in the last 4 months because Caleb is unmanageable. This is a long-standing problem, going back to daycare even before kindergarten. The PMHNP knows that when conducting her initial interview of Caleb she should: A. Anticipate that he can tolerate up to a 45-minute session B. Consider that symbolic play with dolls will be informative C. Interview him alone before involving the parents D. Be clear that he is there because of problem behavior D Treatment of abused children is multimodal and long term. The single most important aspect of treatment is: A. Establishing a safe place for the child B. Exposure related to the feared experience C. Psychoeducation D. Cognitive-behavioral interventions A Psychiatric assessment of the adolescent patient is different in several ways from assessment of younger children. While trying to establish a therapeutic environment with an adolescent who is openly hostile, one of the most important things the PMHNP can do is to: A. Be more liberal in terms of limit setting and tolerating hostility in order to facilitate honest communication B. Ensure the patient that under no circumstances will anything said be repeated to the parents C. Allow silences to last as long as necessary until the patient is inclined to offer any verbal input D. Communicate to the patient that his or her perspective is valued and will not be judged or critiqued A A variety of questionnaires, scales, guided-interview tools, and other standardized instruments are available to aid with various aspects of assessment. The majority are intended only to be used as an aid to information gathering and not to make a diagnosis. Which of the following tools requires training to administer and can be used to determine diagnoses? A. Child and Adolescent Psychiatric Assessment (CAPA) B. Brief Impairment Scale C. Pictorial Instrument for Children and Adolescents (PICA-III-R) D. Achenbach Child Behavior Checklist C The PMHNP is drafting a proposal for research funding for a project to offer primary prevention strategies designed to reduce the incidence of bullying. In support of this project, the PMHNP provides data supporting the fact that both perpetrators and victims of bullying suffer all of the following except: A. Higher incidence of emotional problems B. Greater difficulty making friends C. Poorer academic achievement D. Increased percentage of smoking D Which of the following manifestations of childhood anxiety disorders is considered a psychiatric emergency? A. School refusal B. Bedtime refusal C. Eating refusal D. Speech refusal A The PMHNP is performing an assessment on Julie, a 4-year-old girl who has been brought to care by her mother. The mother was referred by the pediatrician because Julie has been demonstrating an appreciable change in her behavior. She is developmentally on target and has always been a happy and curious child, but for the last few months she seems to be much more fearful and anxious. Which of the following recently acquired behaviors described by the mother is most suspicious for sexual abuse? A. Prolonged periods of daydreaming B. Masturbating with a toy C. Touching the genitals of her 3-year-old cousin D. Showing her genitals to other children at daycare B What is the primary diagnostic difference between obsessive-compulsive disorders in children as compared to adults? A. Age of onset B. Response to treatment C. Recognition that the thoughts or behaviors are irrational D. The thoughts or behaviors occupy > 1 hour daily A With respect to treatment of conduct disorder, the PMHNP knows that: A. The reduction of violence and aggression in school is critical B. Parental psychiatric intervention has not demonstrated improved outcomes C. Atypical antipsychotics are avoided due to the adverse effect profile D. Treatment with psychostimulants exacerbates aggressive behaviors A Kelly is a 13-year-old girl who is being evaluated because her parents are very concerned about her sudden disinterest in school. She does not want to go to any social activities and her grades have dropped markedly in the last several months. When considering bullying as a cause of her behavior change, the PMHP considers that which type of bullying is more common among girls? A. Verbal B. Physical C. Relational D. Cyber A Karen is a 7-year-old girl who has been started on atomoxetine 18 mg once daily for ADHD, which is just under the recommended starting dose of 0.5 mg/kg/day. After just 1 week, her parents report that she is not eating, complains of stomach pain almost every day, is having trouble sleeping, and is “really cranky.” Her teacher says she never seen anything like it; that Karen is actually worse on her ADHD medication. A careful review reveals that Karen is taking her medication just as prescribed. She is not on any other prescribed, over-the-counter, or herbal medications. The PMHNP considers that: A. These are common in the first weeks of therapy and the dose should be increased to a therapeutic regimen B. Karen may be a poor metabolizer of CYP2D6 medications and will need a change of therapy C. Behavioral modalities should be started as optimal management of ADHD is multimodal D. Fluoxetine should be added to the regimen as it has demonstrated efficacy with coincident anxiety A Carolyn is a 14-year-old female who is in care because she has developed increasingly difficult behavior at home and school. She is inappropriately dressed for the interview, wearing heavy makeup and conducting herself in a suggestive manner. Her medical history is significant only for childhood asthma and four urinary tract infections in the last year. Carolyn’s mother reveals that Carolyn’s stepfather has a history of sexually abusing his biological daughter, and the mother is beginning to wonder if something isn’t “going on” in her own home. Carolyn vigorously denies this, and indicates that her stepfather is very good to her, takes care of her, and is her “best friend.” The PMHNP recognizes that Carolyn may be in which phase of intrafamilial sexual abuse? A. Engagement B. Secrecy C. Disclosure D. Suppression B 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, so she did not focus on him. 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. Further assessment reveals that he has always been extremely shy and that he doesn’t like it when people make a fuss over him. 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 D With respect to psychiatric assessment, the PMNHP knows that in terms of confidentiality: A. All information related to a minor may be shared with the parents without the child’s consent. B. Whenever there is a suspicion of neglect or abuse, the appropriate state agency must be notified. C. Every state has laws that emancipate children for issues of mental health. D. All children are entitled to confidentiality unless they are a danger to themselves or others. B The PMHNP is performing a series of court-ordered home visits to evaluate concerns about a 4-month-old infant who presented for a well checkup with clear failure to thrive. While observing the mother’s interaction with the infant, the PMHNP notes a negative pattern of interaction. This is characterized by: A. The child refusing to feed and the mother feeling rejected and withdrawing B. The mother not holding the child during feeding and the child withdrawing C. The mother not responding to hunger cues, e.g., crying, and the child stopping demonstrating them D. The mother being overly protective and trying to feed excessively, and the infant stopping eating B The PMHNP observes separation from and reunion with the parent as part the mental status exam of a 25-month-old toddler. Extremes of emotion during separation or reunion are most consistent with: A. Normal developmental progression at that age B. Cognitive dysfunction C. Neurologic dysfunction D. Problems with the parent-child relationship D The PMHNP is reviewing assessment data on Richard, a 14-year-old boy who was brought in for evaluation by his parents. He has a longstanding history of being difficult, defiant, and argumentative with adults. While considering differential diagnosis of oppositional defiant disorder and conduct disorder, which of the following findings meet criteria for conduct disorder? A. Openly defies rules, argues with adults, is truant from school B. Shoplifts valuable jewelry, is persistently angry and resentful, runs away from home C. Often loses temper in the classroom, upturned a desk at school in anger, is verbally cruel to classmates D. Has a history of physical cruelty to the family cat, broke into the neighbors’ house while they were on vacation, starting fist fights at school D Melanie is a 13-month-old female who has been referred by her primary care pediatrician. She has not had consistent well-child checks, and at her first visit with this pediatrician at age 1 year, there was a notable absence of verbal babbling, interactive play, or smiling. Comprehensive assessment of Melanie must include all the following except: A. The Children’s Apperception Test (CAT) B. A comprehensive history C. A mental status examination