Walden NURS 6660 FINAL EXAM
Question 1 In which demographic is depression twice as prevalent in girls as compared to boys? A. Preschoolers B. School aged
... [Show More] C. Adolescents D. All children
Question 2
Andrew is a 14-year-old male who is being managed for bipolar I disorder. He was started on lithium 6 weeks ago and has achieved a serum level of 1.1 mEq/L according to his most recent blood work. Andrew says he does not feel any different, but both his parents and teachers report improvement in his mood. He has been more stable, is getting along better with friends and siblings, and is even more interested in his schoolwork. The PMHNP plans to maintain Andrew on this medication and knows that he will need which of the following ongoing laboratory assessments?
A. Complete blood count, thyroid function tests, and serum calcium
B. Liver function tests, complete blood count, and 12-lead electrocardiogram C. White blood cell differential, fasting glucose, and fasting lipid profile D. Comprehensive metabolic panel, complete blood count, and thyroid function tests
1 | P a g eQuestion 3
Confidentiality is a complex topic in the world of child and adolescent psychiatry. The last
40 to 50 years have been characterized by increased attention to this issue and the
publication of various ethical codes and practice position statements by professional
organizations. Which of the following is not a true statement with respect to confidentiality
of the child or adolescent client?
A. The PMHNP should not be concerned with consent for disclosure when child abuse
or maltreatment has occurred.
WALDEN UNIVERSITY NURS 6660 FINAL EXAM
B. In 1979, the American Psychiatric Association (APA) stated that children 12 years of
age or older can give consent for disclosure.
C. The American Academy of Child and Adolescent Psychiatry (AACAP) Code of Ethics
states that consent is not required for disclosure.
D. Regardless of code or position statement by any organization, the best approach is
when
the child and PMHNP agree on disclosure.
Question 4
Debi is a 15-year-old girl who is currently being treated for depression. Her parents have
been very proactive and involved in her care, and Debi has achieved remission 2 months
after beginning treatment with a combination of pharmacotherapy and cognitive
behavioral therapy. While counseling Debi’s parents about important issues in
management, the PMHNP advises that:
A. There is a > 50% likelihood that Debi’s younger sibling will develop depressive
symptoms
B. The mean length of major depressive episode in adolescents is 4 months
C.
20 to 40% of adolescents who have major depressive disorder will develop
bipolar I
within
5
yearsD. Adolescent-onset depression typically needs long-term pharmacologic management to
prevent relapse
Question 5
The therapeutic outcomes for children with disorders of written expression are most
favorable when they are characterized by:
Concomitant pharmacotherapy with a psychostimulant to promote attention and
focus
Multimodal therapy to include group interaction with peer-to-peer feedback on writing
samples
A variety of tutors who will offer a variety of writing techniques, composition strategies,
and critiques
Intensive, continuous administration of individually tailored, one-on-one
expressive and
creative
writing
therapy
Question 6
When considering a diagnosis of developmental coordination disorder, the PMHNP knows
that the diagnosis may be associated with:
A. Above-average scores on performance subtests of standardized intelligence testing
B. Below-average scores on verbal subtests of standardized intelligence testing
C.
Soft neurologic signs on physical examination such as slight reflex
abnormalities D. Physical findings consistent with neuromuscular disease such as
muscular dystrophy
3 | P a g eQuestion 7
Caylee is a 5-year-old girl who is referred for evaluation by child protective services. She
was recently removed from her biological family and placed in foster care, as her home
environment was reportedly unsafe due to conditions of extreme neglect. Her foster
mother reports that Caylee is very quiet and withdrawn and always appears sad and
disinterested in her surroundings; however, she becomes very irritable when anything
unexpected or unplanned occurs. The foster mother became very concerned when it
appeared that Caylee was hallucinating. The PMHNP considers that:
A. Caylee is at high risk for suicide and precautions should be taken
B.
C.
The hallucinations are consistent with brief psychotic disorder or schizophrenia
The history and reported symptoms are typical of depressive disorder in young
children
D. This is a common situation when prepubertal children are removed from the
biological
parents regardless of how dysfunctional they are
Question 8
Children with gender dysphoria typically have higher rates of all the following except:
A. Depression
B. Impulse control disorders
C. Anxiety disorders
D. Eating disorder
Question 9
Eileen is a 23-month-old girl who is being evaluated for autism spectrum disorder
because her pediatrician is concerned about the presence of developmental red flags. She
has just a few words of speech and has not put together any meaningful two-word
phrases. While taking a history from Eileen’s mother the PMHNP learns that for
approximately the last 2 months Eileen has been seen eating paint chips that are peelingoff the baseboard and window sills in the family home; when she sees one she puts it in
her mouth. This is a concern because they live in an old farmhouse and there may be
lead-based paint in some of the paint layers. The PMHNP considers that which of the
following is not consistent with a diagnosis of pica?
A. A diagnosis of autism spectrum disorder
B. Symptoms < 6 months duration
C. The pattern of eating
D. Lack of potential consequences
Question 10
The current scholarly consensus is that the etiology of bulimia nervosa is multifactorial to
include biological, sociocultural, family, cognitive-behavioral, and psychodynamic factors.
When considering the etiology of bulimia nervosa, the PMHNP understands that:Family
factors contributing to bulimia nervosa include emotional restraint, tight parental
control of behavior, and avoidance of conflict.
A. Lowered serotonin activity is seen in the brains of patients with bulimia nervosa.
B. There is a disproportionate incidence in childhood sexual abuse in patients with
bulimia nervosa. D.
Cultural influences are much less implicit in the development of bulimia
nervosa as
compared
to
nervosa.
anorexia
Question 11
Standardized instructional programs used in the management of reading disorders
include all the following except:
5 | P a g eA. The Orton Gillingham and Direct Instructional System for Teaching and
Remediation
B. Science Research Associates, Inc. Basic Reading Program
C. Bridge Reading Program
D. Woodcock-Johnson Psychoeducational Battery
Question 12
Which of the following symptom clusters is most likely in a 16-year-old male with major
depressive disorder?
A. Disturbance of mood, loss of interest, and mood-congruent hallucinations
B. Irritability, persistent abdominal complaints, and insomnia
C. Decreased concentration, social withdrawal, and substance abuse D.
Pervasive anhedonia, hopelessness, and severe psychomotor retardation
Question 13
The PMHNP is working with rural primary care providers to increase awareness of
mental health disorders in infancy and early childhood. The program includes a session
on screening for feeding disorders in infants. If an infant is either observed by the
provider or reported by the parent to frequently suck the tongue rhythmically or appear
to strain with his or her back arched and then swallow, the examiner should consider the
possibility of:
A. Gastroesophageal reflux disease
B. Failure to thrive
C. Iron deficiency
D. Inadequate emotional attachmentQuestion 14
An astute pediatrician has referred Kyle, a 5-month-old infant, for evaluation of
rumination disorder. His mother was concerned because he seemed to “want” to
regurgitate every time he ate and would even seem to “put his hand down his throat” in
order to stimulate regurgitation. Kyle had a thorough evaluation and according to the
pediatrician did not have gastroesophageal reflux or hiatal hernia. The mother-infant
relationship appeared to be healthy and, via assessment, the PMHNP could not identify
any clear emotional issues. The primary treatment strategy for Kyle will likely focus on:
A. Aversive therapies, e.g., squirting lemon juice into Kyle’s mouth when he
ruminates
B. Medication therapies to include trials of first-line agents such as metoclopramine,
cimetidine, or haloperidol
C.
Psychotherapy for the parents
D. Habit-reversal therapies
Question 15
The literature indicates that boys whose fathers died before the age of 13 are at a greater
risk for the development of depression as compared to controls. This is consistent with
which general theory of depression etiology?
A. Molecular-genetic
B. Biologic
C.
Psychosocial D. Stress-diathesis
7 | P a g eQuestion 16
Katelyn is a16-year-old girl who presents for therapy with her mother and father. Katelyn
was born with male genitalia but has felt like a female “all of her life.” She says she knew
something was different as far back as she can remember. She always wanted to wear her
mother’s clothes and makeup and play with other girls. Katelyn started dressing and
openly identifying as a girl when she was 13 years old, and her parents are trying to be
supportive but they are struggling. Most recently Katelyn has developed an intimate
partner relationship with Jennifer, a 15-year- old girl who was gender-assigned female at
birth and identifies as a female. Katelyn’s father does not understand the relationship.
The PMHNP explains that Katelyn:
A. Is responding to the male hormonal surges of puberty and will ultimately
Does not have a clear sense of gender identity and may be a candidate for
reparative
therapy to correct her gender identity
issues
identify with her physiologic gender B.
C. Is a transgender female who identifies as lesbian
D. Is a heterosexual male with transvestic disorder
Question 17
All of the following are proposed etiologies of pica except:
A. Nutritional deficiencies
Parental neglect
B. Compensation for oral needs D. Autism spectrum disorderQuestion 18
Christine is a 9-year-old female who presents for care after having been placed in the
local foster care system. She has been in and out of foster care for the last 4 years after
her parents were killed in an automobile accident. Christine has been placed in a variety
of homes and residential care facilities. The PMHNP recognizes that Christine is at high
risk for:
A. Dissociative disorders
B. Post-traumatic stress disorder
C. Impulse-control disorder
D. Attachment disorder
Question 19
While the core features of schizophrenia are essentially the same in children as they are
in adults, the presentation or characterization is sometimes very different given
developmental issues. Unlike adults with schizophrenia, children with schizophrenia do
not have:
A. Classic positive symptoms
B. Poverty of speech content
C. Social rejection D. Delusions of persecution
Question 20
The PMHNP is working with a couple who has been trying for years to conceive and is
now ready to pursue adoption as an option. They are considering all possibilities; private
vs. government-mediated adoption, adopting from another country, adopting a child of a
different race or ethnicity, adopting an older child rather than an infant, and adopting a
child who is currently in foster care vs. one who lives in an orphanage. While counseling
this couple, the PMHNP advises them that:
9 | P a g eB.
A. Younger children adopted from foster care settings have the best outcomes
Children adopted from abuse and neglect situations have better psychological
adaptation
than those adopted as newborns
C.
same-
race
Transracial adoptions have demonstrated greater disruptions as compared to
Adoptions into families as an only child are more successful than those into families
with
biological
children
adoptions D.
Question 21
Mel is a 15-year-old male with a complex psychiatric assessment. He has a long history of
mood instability, behavior problems, and trouble with schoolwork. He was an extremely
active child who, at one time, was put on medication for hyperactivity. After a
comprehensive evaluation, the PMHP recognizes that he meets diagnostic criteria for both
bipolar I disorder and attention deficit hyperactivity disorder (ADHD). The most
successful approach to his management is likely to begin with:
A. Pharmacotherapy for ADHD
B. Pharmacotherapy for bipolar I
C. Parental training and behavioral interventions for ADHD
D. Family-focused psychoeducational (FFT-A) for bipolar IQuestion 22
Bruce and Debbie have made an appointment for a psychiatric consultation for what
amounts to psychiatric genetic counseling. Bruce is 31 years old and Debbie is 28 years
old. They have been married for 3 years and want to have children. Debbie is worried
because she has a diagnosis of schizophrenia. Her symptoms first became evident when
she was in her junior year of college; fortunately, she knew about the disease due to
family history and sought care quickly. She has been very open with Bruce, and they are
both well informed about the disease. Debbie is an only child and her father had
schizophrenia that was not well controlled. He committed suicide when she was 15 years
old. Debbie takes olanzapine and feels well overall. She has a part-time job, functions
well, but is concerned about the genetic nature of her disease. Counseling for Bruce and
Debbie
Schizophrenia is up to eight times more prevalent in first-degree relatives as
compared to
the
general
population.
includes which of the following pieces of information?
A.
B.
C.
Schizophrenia has been isolated to chromosome number 5 and antenatal testing is
available to predict genetic predisposition of the fetus.
Debbie’s age of onset is more highly correlated with incidence in her offspring as
compared to early-onset schizophrenia.
D. Environment is at least as important as genetics with respect to expression of
schizophrenic symptoms.
Question 23
The PMHNP is working with a pediatrician colleague on a journal article to increase
awareness and improve diagnostic strategies for early-onset bipolar disorder. Based upon
a review of the longitudinal research on this disorder, the literature review of this article
should include all the following except:
A. Recovery rates are lower when bipolar disorder has an early-childhood onset
B. Early-onset bipolar disorder presents a greater likelihood of mixed states and
rapid
cycling as compared to adolescent and adult onset
11 | P a g eC. Higher socioeconomic status and lifetime psychosis are predictors of more rapid
cycling
in early-onset bipolar disorder D.
There is a more frequent conversion from bipolar II to bipolar I in
childhood as
compared
to
adults
Treatment of early-onset schizophrenia can be challenging due to the paucity of evidence-
based support for various pharmacotherapeutics and nonpharmacologic interventions. In
a recent study comparing olanzapine to clozapine, outcomes were assessed with the
Clinical Global Impression of Severity of Symptoms Scale and Schedule for the
Assessment of Negative/Positive Symptoms. Clozapine was found to demonstrate
statistically significant superiority in which outcome measure?
A. Alleviating negative symptoms
B. Occurrence of extrapyramidal effects
C.
Sustained remission of symptoms D. Remission of
hallucinations and delusions
Question
24
Question 25
Benjamin is a 4-year-old male who is being evaluated because his mom is afraid that he
may be schizophrenic. There is a history of schizophrenia in the mother’s family; her
maternal aunt, one sister, and one of her brother’s children were all diagnosed with
schizophrenia. Today she reports that Benjamin has episodes during which he appears to
be hallucinating. Sometimes he seems to see things that are not there, and other times he
actually talks with and plays with imaginary people. The PMHNP continues to gather
information from the mother and Benjamin and plans to do some observation of
Benjamin during play. When considering a diagnosis of early-onset schizophrenia, the
PMHNP considers all of the following except:
A. There are virtually no reports of schizophrenia onset before age 5
young
B. Hallucinations are significantly more predictive of schizophrenia than delusions in
childrenC. Benjamin’s symptoms are more likely a consequence of developmental immaturity
D. Benjamin’s family history should always be considered, but at this point the
diagnosis is
Question 26
very unlikely
While counseling the parents of Joshua, a 9-year-old patient with developmental
coordination disorder, the PMHNP advised that the treatment will include:
A. Modified physical education
B. Cognitive behavioral interventions
C. Group sports participation
D. Computer-generated developmental exercises
Question 27
Maria is an 11-year-old girl who has been diagnosed with early-onset schizophrenia. In
writing up her case report for publication, the PMHNP makes it a point to highlight which
of the following historical features that are often seen in schizophrenia of middle
childhood?
A. Onset of hallucinations and delusions before age 6
B. Symptoms easily confused with attention deficit hyperactivity disorder
C. Delayed motor milestones and language acquisition
D. High expressed emotion characterized by overly critical family response
13 | P a g eQuestion 28
Ramon is a 12-year-old male who was started on fluoxetine, 40 mg daily, for major
depressive disorder 6 weeks ago. At his 2-week follow-up, he was feeling well with no
adverse drug effects, and his dose was elevated from 20 to 40 mg. Today he presents for a
routine follow-up visit. He reports that he has been “all wound up” and is frequently
agitated. He cannot sleep well and has trouble focusing at school. His friends say that he
gets upset quickly, and they are starting to avoid him. The most appropriate approach is
to:
A. Taper the fluoxetine off and see if these symptoms improveB. Add a mood stabilizer to the fluoxetine
C. Increase his dose of fluoxetine to 60 mg daily D. Continue the current dose and
reassess in 2 weeks
Question 29
Taryn is a 14-year-old female who is being evaluated as a condition to return to the
private school in which she has been enrolled since fifth grade. She has an ongoing
inability to focus in school, and her mood reportedly ranges from “one extreme to the
other.” Per her mother, she is either overly excited about something and almost
exaggerated in her approach, or she is disinterested and irritable and doesn’t want to
leave her bedroom. She was evaluated several different times in childhood for ADHD, and
even took medication once, but it did not help. In considering a diagnosis of cyclothymic
disorder, the PMHNP considers that:
A. Symptoms need to be present for at least 1 year
B. Symptoms need to be present for at least 2 years
C. Symptoms are not characterized by conduct disorders
D. Symptoms are not characterized by suicidal ideation
Question 30
Which of the following statements best characterized the treatment course and
progression of bulimia nervosa?
A. Cognitive behavioral therapy is considered the benchmark, first-line treatment.
B. Antidepressant medications have not been demonstrated to be effective.
15 | P a g eC. The majority of patients will require hospitalization as an initial intervention.
D. Psychodynamic therapy is extremely successful when patients are not lost to follow-up.
Question 31
The etiology of childhood depression is multifactorial and may include biological factors.
Which of the following is a true statement with respect to hormonal studies in depressed
Prepubertal children having a depressive episode secrete significantly more
growth
hormone during sleep than nondepressed
children.
children? A.
B.
Polysomnography demonstrates significantly reduced rapid eye movement (REM)
during
C.
depressive episodes.
Thyroid stimulating hormone (TSH) levels are elevated > 50% above the upper
limits of
normal in the majority of children with depression.
D. Magnetic resonance imaging (MRI) studies in depressed adolescents reveals low
ventricular volume and increased frontal lobe volume.
Question 32
There is a high incidence of overlap among children with bipolar disorder, attention
deficit hyperactivity disorder, conduct disorder, and anxiety disorders. Which of the
following manic symptoms of bipolar disorder are most closely correlated to conduct
disorder?
A. Insomnia and irritability
B. Physical restlessness and poor judgment
C.
Hallucinations and overeating D. Hyper sexuality
and inattentionQuestion 33
Linda is a 5-year-old girl who has persistent pica; she was finally referred for care when her eating of potentially toxic nonfood substances alarmed her kindergarten teacher. Linda’s mother admits during the history that Linda has been doing this for years, but thought it was not a big deal since Linda did not eat anything dangerous. Linda’s mother must work two Jobs and essentially did not bother to pursue Linda’s unusual symptom because it did not seem unsafe. While discussing management strategies with Linda’s mother, the PMHNP counsels that the most rapidly successful treatment strategy appears to be: A. Aversion therapy
B. Play therapy C. Environmental control D. Cognitive behavioral therapy
Question 34 The leading cause of death in youths living in juvenile residential facilities is:
A. Suicide B. Accident
C. Homicide D. Illness 17 | P a g e [Show Less]