NURS 6660 MIDTERM EXAM QUESTIONS AND ANSWERS Jack is a 3-year-old boy who is being evaluated for developmental delay. The mental status examination is
... [Show More] 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: 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: 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: D Which of the following is the most common anxiety disorder of childhood? 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: B Which of the following behaviors is least suspicious for an adolescent who is being bullied at school? 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: C Which of the following is a true statement with respect to developmental testing in infants? 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? 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: D Treatment of abused children is multimodal and long term. The single most important aspect of treatment is: 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 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? 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: D Which of the following manifestations of childhood anxiety disorders is considered a psychiatric emergency? 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? B What is the primary diagnostic difference between obsessive-compulsive disorders in children as compared to adults? A With respect to treatment of conduct disorder, the PMHNP knows that: 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 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 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? 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: D With respect to psychiatric assessment, the PMNHP knows that in terms of confidentiality: 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: 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: 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? 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: C Despite a wealth of data-based information on bullying, including information about its forms, presenting symptoms, and consequences, current research suggests that accurate information about bullying is not influencing preventive and awareness strategies in most school systems. When advising school personnel, parents, and primary care providers about bullying, the PMHNP should emphasize that: D Minor physical anomalies, such as high-arched palate, low-set ears, and transverse palmar creases, occur in a higher than average distribution in children with all of the following except: D Comprehensive psychiatric assessment of young school-aged children requires a variety of information sources. Input is necessary from parents, caregivers, and teachers because children of this age group cannot reliably provide information about: C Mark is a 5-year-old boy brought in for evaluation because his behavior at school has become so disruptive. According to the parents, Mark’s teacher says he just refuses to follow the rules of the classroom, openly defies her, and actually seems to try and upset his classmates. The teacher says Mark gets frustrated very easily when he cannot complete a task and is resistant to any effort to help him. This happens almost every day, and the teacher has indicated that she will not be able to keep him in the classroom if things do not change. Mark’s parents admit that he has always been “willful” and difficult to manage, but as he is an only child with a stay-at-home mom, the family overlooked his disruptive tendencies and accommodated Mark. The parents report that they often skip social events and family outings because they don’t know how Mark will behave. While counseling Mark’s parents about the theories of causation of oppositional defiant disorder (ODD), the PMHNP tells the parents that psychiatric theories include all of the following except: C Having child and adolescent patients rate their feelings and moods on a scale of 1–10 is most effective in which age group? C Which of the following is a true statement with respect to conduct disorder? C Being Brave: A Program for Coping With Anxiety for Young Children and Their Parents is a manualized intervention for anxiety disorders in young children between the ages of 4 and 7 years old. It uses a combination of parent-only and parent-child sessions and demonstrates significant improvement in children with all forms of anxiety disorders except: C Eric is an 11-year-old male for whom an emergency assessment was requested due to fire- setting. This is not Eric’s first fire, and his parents admit that he has had a bit of a fixation with the fireplace and matches for a few years. During the evaluation, the PMHNP should be particularly alert to other findings consistent with: D Which of the following is a true statement with respect to crisis intervention and psychological debriefing as a preventive strategy for post-traumatic stress disorder (PTSD)? D Which of the following is not a true statement with respect to theorized etiologies of ADHD? A The clinical interview is an important part of psychiatric assessment and should be conducted early in the diagnostic process. However, a comprehensive assessment should include other information-gathering modalities because the clinical interview: C e PMHNP is evaluating a 15-year-old male patient who has been referred by his court- appointed guardian. He has been in foster care for the last 6 years and maintained a steady pattern of low-level behavior problems such as skipping school and ignoring curfew. He is not openly defiant and has always been described as a “loner.” He just does not follow most rules. During the mental status examination, the PMHNP notes that his expressions are sometimes inconsistent with the topic of conversation, and he does not seem to be able to transition effectively among levels of emotion. This represents an abnormality in: B Kevin is a 15-year-old male who presents for court-ordered psychiatric assessment. Kevin comes to his first appointment with both of his parents. He is sitting in the chair with his arms crossed and responds with “yes” and “no” answers to direct questions; otherwise, he volunteers no information. The parents are clearly upset and indicate they just “don’t know what to do with him anymore.” The most appropriate action for the PMHNP would be to: A Which of the following statements is true with respect to children who present to care acutely due to violent, enraged behavior? D Comprehensive psychiatric/mental health assessment of children includes an interview with the parents or caregivers. Which of the following is not a true statement with respect to the parental interview? D [Show Less]