NR-606 FINAL EXAM WITH FULLY
EXPLAINED STUDY GUIDE
What is the DSM-5 definition of ADHD? - ANSWER✔✔✨---A persistent pattern of selective attention
and/or hyperactivity and or impulsivity that interferes with functioning or development. The patient
should usually have 6 or more symptoms of selective attention, hyperactivity and impulsivity for 6
months or longer.
Symptoms interfere with social, academic, or occupational functioning
symptoms are present in two or more setting
What are some s/s of selective attention (refers to the ability to focus on specific information or stimuli
while actively filtering out irrelevant distractions, essentially choosing what to pay attention to) within
children with ADHD? - ANSWER✔✔✨---lack of attention to detail, carelesnessness, not listening,
losing things, diverting attention, forgetfulness.
What are some s/s of impulsivity? - ANSWER✔✔✨---Not waiting your turn, blurting things out,
interrupting, excessive talking
What are some s/s of hyperactivity? - ANSWER✔✔✨---trouble playing quietly, leaving ones set,
running/climbing, fidgeting
What are some s/s of lack of sustained attention? - ANSWER✔✔✨---poor problem solving, difficulty
completing tasks, disorganization, difficulty sustaining mental effort
When is ADHD usually diagnosed and what gender does it mainly affect? - ANSWER✔✔✨---It is
diagnosed within early childhood to adolescents.
ADHD has a 2:1 male to female ratio.
What is the importance of early ADHD diagnosis and treatment? - ANSWER✔✔✨---ADHD symptoms
may be mild or so severe and persistent that they interfere with virtually all aspects of a person's life.
Without early identification and proper treatment, ADHD can cause disruptions in academic
performance, family stress, difficulties in social relationships, and accidental injuries.
What are the lasting consequences of non-treatment of ADHD in children? - ANSWER✔✔✨---
Children with ADHD may experience delays in speech, motor, and social development. They often
demonstrate reduced behavioral inhibition, emotional dys-regulation or impulsivity, and negative
emotionality. Some children with ADHD have challenges with working memory.
,ADHD typically presents with_________ IN EARLY CHILDHOOD. - ANSWER✔✔✨---HYPERACTIVITY
What is the difficult about diagnosing ADHD in children under the age of 4? - ANSWER✔✔✨---It can
be hard to distinguish actually ADHD symptoms from normal neurotypical children.
_______ FEATURES become more prominent in PRESCHOOL and ELEMENTARY school, which is when
ADHD is most often diagnosed. - ANSWER✔✔✨---Inattentive.
Young children can experience developmental delays and may engage in behaviors that are less mature
than their peers.
In adolescence, signs of hyperactivity become less common, but some adolescents experience a
worsening of the condition with development of _______ behaviors. - ANSWER✔✔✨---Anti-social
Teens with ADHD are at risk for poor academic performance, problems with driving, difficulties with
social situations, risky sexual behavior, and substance abuse.- Particularly untreated
As clients reach adolescence, hyperactive symptoms may decline and become less apparent to others,
but adolescents and adults with ADHD may still struggle with executive function, attention, and working
memory, which can create problems with day-to-day functioning, performance at work, and
relationships. - ANSWER✔✔✨---
How would you as a PMHNP screen or diagnose ADHD? - ANSWER✔✔✨---To make an informed
diagnosis, it is essential to gather data from multiple sources, including the client, parents, and teachers
of children and adolescents. Several instruments are available, either free or for a fee, to assist in
diagnosis, as well as to monitor changes in symptoms during treatment.
You can use the Vanderbilt scale- FREE
Connor Scale- not free
What are some co-morbidities of ADHD? - ANSWER✔✔✨---Substance use disorder, depression,
anxiety, OCD, Bipolar
Common co-occurring conditions include learning disabilities, conduct disorders, tics, anxiety,
depression, and language disorders; adolescents are at increased risk of substance use disorders.
Consideration must be given to whether the presenting symptoms are attributed to ADHD, another
disorder, or to both disorders to make an accurate diagnosis and treatment plan.
How is treatment typically handled when a child has ADHD AND a co-existing mental health ailment? -
ANSWER✔✔✨---Children with co-occurring conditions are often treated first for ADHD and then for
comorbidities, as treating ADHD symptoms first may help reduce overall stress levels and provide a
clearer picture of the comorbid symptoms
,What is the first-line treatment for ADHD? - ANSWER✔✔✨---A stimulant medication.
A non-stimulant is used if a stimulant is contraindicated or if a stimulant is not effective.
However remember that treatment of ADHD is multi-modal, often requiring medical, educational,
behavioral, and psychological intervention.
________ can help lower distractibility and improve attention, working memory, and impulsivity. -
ANSWER✔✔✨---Non-stimulants
How would you treat a patient who is having argumentative or oppositional symptoms? -
ANSWER✔✔✨---A combination of stimulants and non-stimulants can be used
What cardiac considerations should be considered before starting any patients on a stimulant? -
ANSWER✔✔✨---A cardiac workup should be completed.
An electrocardiogram (EKG) is required if cardiac history is present in a first-degree relative. (it can help
identify potential underlying heart conditions that could be adversely affected by the medication, even if
the patient appears healthy, as stimulants can slightly increase heart rate and blood pressure,
potentially causing complications in individuals with undiagnosed heart issues; this practice is
recommended by the American Heart Association (AHA) to prioritize patient safety. ) and ensure to
document this.
What bio-metric considerations should be considered before starting any patients on a stimulant? -
ANSWER✔✔✨---Monitor BP, height and weight during every appointment. (ensure the child is not
experiencing abnormal BP, ensure stimulant is not affecting the child's growth and development. Ensure
the medication is not cause anorexia within the patient. Stimulants decrease appetite.
What mental health considerations should be considered before starting any patients on a stimulant? -
ANSWER✔✔✨---- Assess all clients for bipolar disorder before treatment.
Central nervous system (CNS) stimulants may cause psychotic or manic symptoms in clients with no
prior history or may exacerbate behavior disturbance symptoms and thought disorders in clients with
pre-existing psychosis.
- CNS stimulants may exacerbate comorbid anxiety and substance use disorders.
What are two teaching points for patients if they begin to complain of insomnia while on a stimulant? -
ANSWER✔✔✨---Take the medication AT NIGHT or do not take the medication past a certain time.
Increased irritability and insomnia can be treated with a low dose of nonstimulant medication which will
allow the client to fall asleep.
, If a patient has current tics, what is a great teaching recommendation? - ANSWER✔✔✨---Stimulants
can cause or worsen tics; stimulants may unmask the presence of tics.
How soon would a patient/parents see the efficacy of a stimulant or non-stimulant? -
ANSWER✔✔✨---within the first week! These medications begin to work 30-60 minutes after
ingestion and last for a duration of up to 4-12 hours.
If a patient needed to be switched from one stimulant medication to the next, how would you do it? -
ANSWER✔✔✨---Discontinue one medication and start the next medication at the starting dose the
next day. NOT THE SAME DAY
How would you educate the patient on how to discontinue an ADHD medication? - ANSWER✔✔✨---
Abrupt withdrawal can cause irritability and rebound symptoms after prolonged use. Medication needs
to be tapered via PMHNP.
If a patient's parent asked if their childs ADHD medication had a high possibility for addiction, what
would you say? - ANSWER✔✔✨---Several stimulant medications are classified as Schedule II
indicating that they have a high potential for abuse.
The PMHNP must adhere to federal and state-specific guidelines for prescribing these medications.
Careful monitoring is required. Occasional urine drug screens should be obtained to verify the presence
of amphetamines and the absence of other substances of abuse.
What type of stimulants are at the highest risk for abuse or diversion? - ANSWER✔✔✨---Ritalin,
Adderall and Dexedrine
short-acting medications are at higher risk for diversion (Short-acting medications for ADHD that are
considered high risk for diversion include methylphenidate (Ritalin), mixed amphetamine salts
(Adderall), and dextroamphetamine (Dexedrine), as they take effect quickly and wear off relatively fast,
making them more susceptible to misuse and potential for diversion.)
Sustained release medications are better for preventing this.
What are some common side effects of stimulants? - ANSWER✔✔✨---restlessness, irritability,
anxiety, insomnia, stomachache, headaches, tics, and worsening aggression symptoms
a worsening of symptoms or "crash" may occur when the medication wears off, especially with
immediate-release (IR) medications
EXPLAINED STUDY GUIDE
What is the DSM-5 definition of ADHD? - ANSWER✔✔✨---A persistent pattern of selective attention
and/or hyperactivity and or impulsivity that interferes with functioning or development. The patient
should usually have 6 or more symptoms of selective attention, hyperactivity and impulsivity for 6
months or longer.
Symptoms interfere with social, academic, or occupational functioning
symptoms are present in two or more setting
What are some s/s of selective attention (refers to the ability to focus on specific information or stimuli
while actively filtering out irrelevant distractions, essentially choosing what to pay attention to) within
children with ADHD? - ANSWER✔✔✨---lack of attention to detail, carelesnessness, not listening,
losing things, diverting attention, forgetfulness.
What are some s/s of impulsivity? - ANSWER✔✔✨---Not waiting your turn, blurting things out,
interrupting, excessive talking
What are some s/s of hyperactivity? - ANSWER✔✔✨---trouble playing quietly, leaving ones set,
running/climbing, fidgeting
What are some s/s of lack of sustained attention? - ANSWER✔✔✨---poor problem solving, difficulty
completing tasks, disorganization, difficulty sustaining mental effort
When is ADHD usually diagnosed and what gender does it mainly affect? - ANSWER✔✔✨---It is
diagnosed within early childhood to adolescents.
ADHD has a 2:1 male to female ratio.
What is the importance of early ADHD diagnosis and treatment? - ANSWER✔✔✨---ADHD symptoms
may be mild or so severe and persistent that they interfere with virtually all aspects of a person's life.
Without early identification and proper treatment, ADHD can cause disruptions in academic
performance, family stress, difficulties in social relationships, and accidental injuries.
What are the lasting consequences of non-treatment of ADHD in children? - ANSWER✔✔✨---
Children with ADHD may experience delays in speech, motor, and social development. They often
demonstrate reduced behavioral inhibition, emotional dys-regulation or impulsivity, and negative
emotionality. Some children with ADHD have challenges with working memory.
,ADHD typically presents with_________ IN EARLY CHILDHOOD. - ANSWER✔✔✨---HYPERACTIVITY
What is the difficult about diagnosing ADHD in children under the age of 4? - ANSWER✔✔✨---It can
be hard to distinguish actually ADHD symptoms from normal neurotypical children.
_______ FEATURES become more prominent in PRESCHOOL and ELEMENTARY school, which is when
ADHD is most often diagnosed. - ANSWER✔✔✨---Inattentive.
Young children can experience developmental delays and may engage in behaviors that are less mature
than their peers.
In adolescence, signs of hyperactivity become less common, but some adolescents experience a
worsening of the condition with development of _______ behaviors. - ANSWER✔✔✨---Anti-social
Teens with ADHD are at risk for poor academic performance, problems with driving, difficulties with
social situations, risky sexual behavior, and substance abuse.- Particularly untreated
As clients reach adolescence, hyperactive symptoms may decline and become less apparent to others,
but adolescents and adults with ADHD may still struggle with executive function, attention, and working
memory, which can create problems with day-to-day functioning, performance at work, and
relationships. - ANSWER✔✔✨---
How would you as a PMHNP screen or diagnose ADHD? - ANSWER✔✔✨---To make an informed
diagnosis, it is essential to gather data from multiple sources, including the client, parents, and teachers
of children and adolescents. Several instruments are available, either free or for a fee, to assist in
diagnosis, as well as to monitor changes in symptoms during treatment.
You can use the Vanderbilt scale- FREE
Connor Scale- not free
What are some co-morbidities of ADHD? - ANSWER✔✔✨---Substance use disorder, depression,
anxiety, OCD, Bipolar
Common co-occurring conditions include learning disabilities, conduct disorders, tics, anxiety,
depression, and language disorders; adolescents are at increased risk of substance use disorders.
Consideration must be given to whether the presenting symptoms are attributed to ADHD, another
disorder, or to both disorders to make an accurate diagnosis and treatment plan.
How is treatment typically handled when a child has ADHD AND a co-existing mental health ailment? -
ANSWER✔✔✨---Children with co-occurring conditions are often treated first for ADHD and then for
comorbidities, as treating ADHD symptoms first may help reduce overall stress levels and provide a
clearer picture of the comorbid symptoms
,What is the first-line treatment for ADHD? - ANSWER✔✔✨---A stimulant medication.
A non-stimulant is used if a stimulant is contraindicated or if a stimulant is not effective.
However remember that treatment of ADHD is multi-modal, often requiring medical, educational,
behavioral, and psychological intervention.
________ can help lower distractibility and improve attention, working memory, and impulsivity. -
ANSWER✔✔✨---Non-stimulants
How would you treat a patient who is having argumentative or oppositional symptoms? -
ANSWER✔✔✨---A combination of stimulants and non-stimulants can be used
What cardiac considerations should be considered before starting any patients on a stimulant? -
ANSWER✔✔✨---A cardiac workup should be completed.
An electrocardiogram (EKG) is required if cardiac history is present in a first-degree relative. (it can help
identify potential underlying heart conditions that could be adversely affected by the medication, even if
the patient appears healthy, as stimulants can slightly increase heart rate and blood pressure,
potentially causing complications in individuals with undiagnosed heart issues; this practice is
recommended by the American Heart Association (AHA) to prioritize patient safety. ) and ensure to
document this.
What bio-metric considerations should be considered before starting any patients on a stimulant? -
ANSWER✔✔✨---Monitor BP, height and weight during every appointment. (ensure the child is not
experiencing abnormal BP, ensure stimulant is not affecting the child's growth and development. Ensure
the medication is not cause anorexia within the patient. Stimulants decrease appetite.
What mental health considerations should be considered before starting any patients on a stimulant? -
ANSWER✔✔✨---- Assess all clients for bipolar disorder before treatment.
Central nervous system (CNS) stimulants may cause psychotic or manic symptoms in clients with no
prior history or may exacerbate behavior disturbance symptoms and thought disorders in clients with
pre-existing psychosis.
- CNS stimulants may exacerbate comorbid anxiety and substance use disorders.
What are two teaching points for patients if they begin to complain of insomnia while on a stimulant? -
ANSWER✔✔✨---Take the medication AT NIGHT or do not take the medication past a certain time.
Increased irritability and insomnia can be treated with a low dose of nonstimulant medication which will
allow the client to fall asleep.
, If a patient has current tics, what is a great teaching recommendation? - ANSWER✔✔✨---Stimulants
can cause or worsen tics; stimulants may unmask the presence of tics.
How soon would a patient/parents see the efficacy of a stimulant or non-stimulant? -
ANSWER✔✔✨---within the first week! These medications begin to work 30-60 minutes after
ingestion and last for a duration of up to 4-12 hours.
If a patient needed to be switched from one stimulant medication to the next, how would you do it? -
ANSWER✔✔✨---Discontinue one medication and start the next medication at the starting dose the
next day. NOT THE SAME DAY
How would you educate the patient on how to discontinue an ADHD medication? - ANSWER✔✔✨---
Abrupt withdrawal can cause irritability and rebound symptoms after prolonged use. Medication needs
to be tapered via PMHNP.
If a patient's parent asked if their childs ADHD medication had a high possibility for addiction, what
would you say? - ANSWER✔✔✨---Several stimulant medications are classified as Schedule II
indicating that they have a high potential for abuse.
The PMHNP must adhere to federal and state-specific guidelines for prescribing these medications.
Careful monitoring is required. Occasional urine drug screens should be obtained to verify the presence
of amphetamines and the absence of other substances of abuse.
What type of stimulants are at the highest risk for abuse or diversion? - ANSWER✔✔✨---Ritalin,
Adderall and Dexedrine
short-acting medications are at higher risk for diversion (Short-acting medications for ADHD that are
considered high risk for diversion include methylphenidate (Ritalin), mixed amphetamine salts
(Adderall), and dextroamphetamine (Dexedrine), as they take effect quickly and wear off relatively fast,
making them more susceptible to misuse and potential for diversion.)
Sustained release medications are better for preventing this.
What are some common side effects of stimulants? - ANSWER✔✔✨---restlessness, irritability,
anxiety, insomnia, stomachache, headaches, tics, and worsening aggression symptoms
a worsening of symptoms or "crash" may occur when the medication wears off, especially with
immediate-release (IR) medications
