NR 606 Midterm Actual Exam Newest Actual Exam With Complete Questions
And Correct Detailed Answers (Verified Answers) |Already Graded A+
Question 1
In Piaget’s stages of cognitive development, children in the pre-operational stage (typically ages
2 to 7) are characterized by which type of cognitive processing?
A) Inductive reasoning and logical organization
B) Abstract reasoning and hypothetical problem solving
C) Thinking symbolically and using words or pictures to represent objects
D) Coordination of sensory intake with motor actions
E) Mastery of conservation and reversibility
Correct Answer: C) thinking symbolically and using words or pictures to represent objects
Rationale: According to Jean Piaget, the pre-operational stage is defined by the emergence
of language and symbolic play. While children begin to use symbols (words and images) to
represent the world, their thinking is still egocentric and they struggle with logic, such as
the concept of conservation. They cannot yet perform "operations" or mental reversals of
actions.
Question 2
Between the ages of 7 and 11, children enter the concrete operational stage. Which cognitive
milestone is most representative of this period?
A) The ability to consider ethical and political issues in depth
B) The use of reflexes to interact with the environment
C) Thinking becomes more logical and organized, and children can reason inductively
D) The development of object permanence
E) Primarily egocentric perspectives with no logical structure
Correct Answer: C) thinking becomes more logical and organized about events and children
can reason inductively
Rationale: In the concrete operational stage, children transition from intuitive to logical
thought. They can apply logic to physical (concrete) objects and understand the concept of
conservation. Inductive reasoning—going from specific observations to a general
principle—becomes possible, although they still struggle with purely abstract or
hypothetical concepts.
, 2
Question 3
The formal operations stage (ages 12 and up) represents the peak of Piaget’s cognitive model.
What defines this stage?
A) Understanding that an object exists even when hidden
B) The ability to reason abstractly and consider hypothetical problems, moral, and ethical issues
C) Reliance on trial-and-error to solve physical puzzles
D) Logical thinking strictly limited to objects the child can see
E) The primary use of transductive reasoning
Correct Answer: B) the ability to reason abstractly and consider hypothetical problems as
well as moral, ethical, social, and political issues?
Rationale: Formal operational thought allows adolescents to move beyond the "here and
now." They can engage in deductive reasoning, systematic planning, and the evaluation of
ideologies. This stage is critical for the development of an individual’s identity and their
capacity to navigate complex social and moral landscapes.
Question 4
A PMHNP is concerned that a minor patient may be a victim of parental abuse. Under HIPAA
regulations, what is the provider's authority regarding the parent's access to the child's health
information?
A) The parent always has a constitutional right to all records.
B) The provider can decide whether or not to treat the parent as a personal representative.
C) The provider must hand over records but can redact specific notes.
D) The provider is legally required to share all information to maintain the family unit.
E) Access is determined solely by the child, regardless of age.
Correct Answer: B) the provider can decide whether or not to treat the parent as a personal
representative
Rationale: HIPAA provides a specific exception for cases where a provider has a reasonable
belief that a patient has been or may be subjected to domestic violence, abuse, or neglect by
a personal representative. In such cases, the provider may conclude that it is not in the best
, 3
interest of the patient to treat the person as the personal representative, thereby restricting
their access to the patient’s protected health information (PHI).
Question 5
When determining if a parent can access their child's psychiatric records when they are NOT the
"personal representative" under HIPAA, which factor is most influential?
A) The provider’s personal opinion of the parent
B) The child's grade level in school
C) The specific state laws regarding the sharing of health information
D) The parent's insurance status
E) The size of the medical facility
Correct Answer: C) depending on state laws- if the state has a law against it then no, if the
state does permit the provider to share health information then the provider is able to
Rationale: While HIPAA provides a federal floor for privacy, it often defers to state law
regarding the rights of parents and minors. If a state law prohibits disclosure to a parent
(common in cases involving reproductive health or substance use), HIPAA respects that. If
state law is silent, the provider exercises professional judgment.
Question 6
What is a primary challenge for a PMHNP when prescribing psychoactive medications during
the perinatal period?
A) There are too many randomized controlled trials (RCTs) to review.
B) The paucity of evidence regarding the true risks for the pregnant client and developing fetus.
C) Insurance companies always refuse to pay for these medications.
D) Pregnant women metabolize drugs exactly the same as non-pregnant women.
E) Psychotropic medications are never effective during pregnancy.
Correct Answer: B) the paucity of evidence regarding the true risks for the pregnant client
and developing fetus
Rationale: Ethical constraints prevent pregnant women from being included in most clinical
drug trials. As a result, much of our data comes from observational studies and registries.
, 4
This lack of robust "Gold Standard" evidence makes risk-benefit analysis difficult and
requires the PMHNP to stay updated on the latest available registry data.
Question 7
A pregnant client who is stable on a current antidepressant regimen expresses fear about the
medication's effect on the fetus. What is the standard clinical guideline for the PMHNP?
A) Stop the medication immediately to protect the fetus.
B) Switch the medication to a "safer" one in the same class.
C) Keep them on the current medication rather than switching if they are stable.
D) Double the dose because of increased blood volume.
E) Replace the medication with herbal supplements.
Correct Answer: C) keep them on current med rather than switching
Rationale: Switching medications during pregnancy carries a risk of relapse and exposes the
fetus to a second drug. If a patient is stable, the consensus is generally to maintain the
current treatment at the lowest effective dose. Stability is vital, as untreated maternal
mental illness poses its own significant risks to fetal development and neonatal outcomes.
Question 8
In which scenario should a PMHNP refer a pregnant client to a specialized perinatal psychiatrist?
A) Whenever the client asks for a second opinion
B) If the client has a history of mild anxiety
C) When the patient is on a high-risk medication for pregnancy
D) Only if the client is over the age of 40
E) If the client is also taking a prenatal vitamin
Correct Answer: C) when the patient is on a high-risk medication for pregnancy
Rationale: High-risk medications (such as Lithium, Clozapine, or Valproic Acid) require
specialized monitoring of serum levels, fetal echocardiograms, or intensive neonatal follow-
up. A perinatal psychiatrist has advanced training in navigating the complex interplay
between severe mental illness and high-risk pharmacotherapy during gestation.
Question 9
What is the most common adverse effect observed in neonates born to mothers taking SSRIs or
And Correct Detailed Answers (Verified Answers) |Already Graded A+
Question 1
In Piaget’s stages of cognitive development, children in the pre-operational stage (typically ages
2 to 7) are characterized by which type of cognitive processing?
A) Inductive reasoning and logical organization
B) Abstract reasoning and hypothetical problem solving
C) Thinking symbolically and using words or pictures to represent objects
D) Coordination of sensory intake with motor actions
E) Mastery of conservation and reversibility
Correct Answer: C) thinking symbolically and using words or pictures to represent objects
Rationale: According to Jean Piaget, the pre-operational stage is defined by the emergence
of language and symbolic play. While children begin to use symbols (words and images) to
represent the world, their thinking is still egocentric and they struggle with logic, such as
the concept of conservation. They cannot yet perform "operations" or mental reversals of
actions.
Question 2
Between the ages of 7 and 11, children enter the concrete operational stage. Which cognitive
milestone is most representative of this period?
A) The ability to consider ethical and political issues in depth
B) The use of reflexes to interact with the environment
C) Thinking becomes more logical and organized, and children can reason inductively
D) The development of object permanence
E) Primarily egocentric perspectives with no logical structure
Correct Answer: C) thinking becomes more logical and organized about events and children
can reason inductively
Rationale: In the concrete operational stage, children transition from intuitive to logical
thought. They can apply logic to physical (concrete) objects and understand the concept of
conservation. Inductive reasoning—going from specific observations to a general
principle—becomes possible, although they still struggle with purely abstract or
hypothetical concepts.
, 2
Question 3
The formal operations stage (ages 12 and up) represents the peak of Piaget’s cognitive model.
What defines this stage?
A) Understanding that an object exists even when hidden
B) The ability to reason abstractly and consider hypothetical problems, moral, and ethical issues
C) Reliance on trial-and-error to solve physical puzzles
D) Logical thinking strictly limited to objects the child can see
E) The primary use of transductive reasoning
Correct Answer: B) the ability to reason abstractly and consider hypothetical problems as
well as moral, ethical, social, and political issues?
Rationale: Formal operational thought allows adolescents to move beyond the "here and
now." They can engage in deductive reasoning, systematic planning, and the evaluation of
ideologies. This stage is critical for the development of an individual’s identity and their
capacity to navigate complex social and moral landscapes.
Question 4
A PMHNP is concerned that a minor patient may be a victim of parental abuse. Under HIPAA
regulations, what is the provider's authority regarding the parent's access to the child's health
information?
A) The parent always has a constitutional right to all records.
B) The provider can decide whether or not to treat the parent as a personal representative.
C) The provider must hand over records but can redact specific notes.
D) The provider is legally required to share all information to maintain the family unit.
E) Access is determined solely by the child, regardless of age.
Correct Answer: B) the provider can decide whether or not to treat the parent as a personal
representative
Rationale: HIPAA provides a specific exception for cases where a provider has a reasonable
belief that a patient has been or may be subjected to domestic violence, abuse, or neglect by
a personal representative. In such cases, the provider may conclude that it is not in the best
, 3
interest of the patient to treat the person as the personal representative, thereby restricting
their access to the patient’s protected health information (PHI).
Question 5
When determining if a parent can access their child's psychiatric records when they are NOT the
"personal representative" under HIPAA, which factor is most influential?
A) The provider’s personal opinion of the parent
B) The child's grade level in school
C) The specific state laws regarding the sharing of health information
D) The parent's insurance status
E) The size of the medical facility
Correct Answer: C) depending on state laws- if the state has a law against it then no, if the
state does permit the provider to share health information then the provider is able to
Rationale: While HIPAA provides a federal floor for privacy, it often defers to state law
regarding the rights of parents and minors. If a state law prohibits disclosure to a parent
(common in cases involving reproductive health or substance use), HIPAA respects that. If
state law is silent, the provider exercises professional judgment.
Question 6
What is a primary challenge for a PMHNP when prescribing psychoactive medications during
the perinatal period?
A) There are too many randomized controlled trials (RCTs) to review.
B) The paucity of evidence regarding the true risks for the pregnant client and developing fetus.
C) Insurance companies always refuse to pay for these medications.
D) Pregnant women metabolize drugs exactly the same as non-pregnant women.
E) Psychotropic medications are never effective during pregnancy.
Correct Answer: B) the paucity of evidence regarding the true risks for the pregnant client
and developing fetus
Rationale: Ethical constraints prevent pregnant women from being included in most clinical
drug trials. As a result, much of our data comes from observational studies and registries.
, 4
This lack of robust "Gold Standard" evidence makes risk-benefit analysis difficult and
requires the PMHNP to stay updated on the latest available registry data.
Question 7
A pregnant client who is stable on a current antidepressant regimen expresses fear about the
medication's effect on the fetus. What is the standard clinical guideline for the PMHNP?
A) Stop the medication immediately to protect the fetus.
B) Switch the medication to a "safer" one in the same class.
C) Keep them on the current medication rather than switching if they are stable.
D) Double the dose because of increased blood volume.
E) Replace the medication with herbal supplements.
Correct Answer: C) keep them on current med rather than switching
Rationale: Switching medications during pregnancy carries a risk of relapse and exposes the
fetus to a second drug. If a patient is stable, the consensus is generally to maintain the
current treatment at the lowest effective dose. Stability is vital, as untreated maternal
mental illness poses its own significant risks to fetal development and neonatal outcomes.
Question 8
In which scenario should a PMHNP refer a pregnant client to a specialized perinatal psychiatrist?
A) Whenever the client asks for a second opinion
B) If the client has a history of mild anxiety
C) When the patient is on a high-risk medication for pregnancy
D) Only if the client is over the age of 40
E) If the client is also taking a prenatal vitamin
Correct Answer: C) when the patient is on a high-risk medication for pregnancy
Rationale: High-risk medications (such as Lithium, Clozapine, or Valproic Acid) require
specialized monitoring of serum levels, fetal echocardiograms, or intensive neonatal follow-
up. A perinatal psychiatrist has advanced training in navigating the complex interplay
between severe mental illness and high-risk pharmacotherapy during gestation.
Question 9
What is the most common adverse effect observed in neonates born to mothers taking SSRIs or
