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Walden NURS 6660 Final Exam/ Walden NURS6660 Final Exam ( 2019) (Already graded A)

NURS 6660 Final Exam/ NURS6660 Final Exam/ NURSE 6660 Final Exam/ NURSE6660 Final Exam: Walden University Question 1 In which demographic is depression twice as prevalent in girls as compared to boys? A. Preschoolers B. School aged 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 doesn’t 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 Question3 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. 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 years D. 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 8 The PMHNP is evaluating a 15-year-old male patient who has been referred by his courtappointed 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: A. Mood B. Affect C. Thought process and content D. Judgment and insight Question: 9 A variety of diagnostic instruments are available to assist the PMHNP with comprehensive data collection. Which of the following tools is considered an ―interviewer-based‖ tool designed as a guide to clinicians designed to help clarify answers to questions? A. The Children's Interview for Psychiatric Symptoms (ChIPS) B. The Diagnostic Interview for Children and Adolescents (DICA) C. The Pictorial Instrument for Children and Adolescents (PICA-III-R) D. The Child and Adolescent Psychiatric Assessment (CAPA) Question: 10 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. Ask the parents to step out and interview Kevin privately B. Have Kevin complete the standardized-testing assessment C. Schedule session two after reviewing court documentation D. Arrange for three sessions with a family therapist then reevaluate Kevin Question: 11 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 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 performing an emergency assessment on Renee, a 9-year-old girl who was initially brought to the attention of social services by her maternal grandmother. Renee is reluctant to talk about herself or her home life. The physical examination that accompanied this emergency assessment revealed a variety of ecchymoses in various stages of healing, and the examiner was suspicious that there was a history of sexual abuse. Renee is quiet and passive during the interview, but is rather aggressive when playing with dolls. While considering the need for removal from the home, the PMHNP knows that all the following are risk factors for predictors of further abuse and maltreatment except: A. Neglect as the form of maltreatment B. Parental conflict C. Number of previous episodes D. Gender of the victim Question 14 6Harmony is a 4-year-old female who has been through several evaluations for behavioral abnormalities that have become increasingly disruptive, and the family is concerned for the safety of both Harmony and her 2-year-old brother. Comprehensive assessment of Harmony includes neuropsychiatric testing. The PMHNP documents the presence of neurological hard signs. These suggest: A. Brain lesions B. Early-onset schizophrenia C. Low intelligence D. Learning disability Question 15 7During 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 Question 16 The PMHNP has been retained by the local school board to provide comprehensive counseling and guidance following an episode of tragic school violence. A 9th grader, acting alone, brought a gun into the school, fatally shooting a teacher and injuring four other teachers and students before he was subdued. In an effort to promote best healthy practices after this traumatic event, the school board is asking for advice on how to best manage the students. The PMHNP knows that the immediate priority must be: A. Returning to normal routine immediately B. Development of peer counseling groups C. Establishing the perception of safety D. A memorial service to process the loss Question 17 Jenny is a 5-year-old female who has been referred for consultation because the emergency room physician suspects that she might be subject to physical abuse in the home. On evaluation, the PMHNP finds Jenny to be fearful, docile, and guarded. Although clearly in pain, Jenny seems surprised when the PMHNP attempts to provide some comfort. The PMHNP notes that: A. If Jenny demonstrates abnormal attachment with her mother, this will complete textbook criteria for symptoms of physical abuse B. There must be a consistent pattern of atypical physical injury to support the diagnosis of physical abuse C. Jenny's behaviors are more consistent with sexual abuse than physical abuse D. These same symptoms may occur in the absence of any abuse and are neither specific orpathognomic for abuse Question 18 Kelly is an 8-year-old girl who is being evaluated by the PMHNP because she is markedly behind her peers in school performance. During her mental status examination, she is unable to repeat three objects after five minutes, and is unable to repeat five digits forward or three digits backward. Further evaluation reveals an inability to add single digits. The PMHNP interprets this finding as: A. Consistent with her developmental milestone expectations B. A manifestation of profound anxiety C. Reflective of brain damage or learning disabilities D. Suggestive of an abnormality of thought process Question 19 Richard is an 11-year-old patient who has been hospitalized following a suicide attempt in which he mixed a variety of household cleansers and poisons and swallowed them. He has been medically cleared, and his initial psychiatric assessment reveals a preadolescent male who made this suicide attempt because he was so unhappy at school. His family recently moved from another part of the country and he started a new school. The other children have been bullying him, and he just decided it would be better to die. He has no siblings and no friends in this new town. Which additional findings during this assessment would prompt the PMHNP to suggest a psychiatric admission? A. His mother has a history of severe post-partum depression B. A finding of mild depression during this examination C. Appreciable ambivalence about suicide D. absence of any other psychiatric diagnoses Question 20 The PMHNP is discussing autism spectrum disorder (ASD) treatment strategies with the parents of 4-year-old Jeffrey. He is nonverbal and has been completely unable to adapt to any changes of environment; an effort to put him in a preschool class was what precipitated his evaluation and eventual diagnosis. At this point, Jeffrey's parents are very committed to doing anything necessary to support Jeffrey's growth and development and promotion of prosocial behavior. While developing his plan of care, the PMHNP suggests: A. Structured classroom training with consistent behavioral programs B. Facilitated communication with a computer or letter/picture board C. A trial of escitalopram daily to promote decreased irritability D. An atypical antipsychotic as needed to decrease self-injurious behavior Question 21 The PMHNP is writing an article to increase awareness among pediatric primary care providers to those factors that may suggest higher than average risk for the development of childhood anxiety disorders. It is helpful to note that which of the following are neurophysiologic correlates between young children and anxiety disorders? A. Delayed developmental milestones B. Elevated resting heart rate C. Pupillary constriction during cognitive tasks D. Youngest child in birth order Question 22 The PMHNP is evaluating the data he has collected in the assessment of Anna, a 9-yearold girl who presented for evaluation because her teacher strongly encouraged Anna's mother to seek care. According to the teacher, Anna has been consistently disruptive in the classroom since the beginning of the school year, 2 months ago. The assessment includes unstructured interviews with Anna, her mother, and grandmother, and Connors Parent or Teacher Rating Scale for ADHD completed by her primary school teacher and mother. The PMNHP notes a marked disparity among reports—they all seem to contradict each other. The PMHNP considers that this apparent contradiction: A. Likely indicates a subjective bias from the mother or teacher B. May accurately reflect Anna's behavior in different settings C. Requires that other adults exposed to Anna's behavior provide input D. Indicates that a different approach to Anna's assessment is necessary Question 23 The PMHNP is evaluating 12-year-old Dale after the police were called to the home. Dale is assessed as having a psychotic episode; he tells the NP that voices are telling him that he is bad and that he should hurt himself. According to the mother, he has no history of psychiatric disease, medications, or really any concerns at all. Mom says he goes to school, has friends, and has always seemed ―normal.‖ An interview with his 13-year-old sister reveals that while there is no long-term history of abnormal behavior, for the last couple of weeks things have been very strange at home. His father has been arrested for ―something to do with a teenage girl,‖ and their parents have been fighting. His father lost his job, and there is a lot of talk about money and lawyers and jail. Dale has been very emotional as he has always been close to his Dad; he seems to go from crying to laughing in a blink, and is getting in fights at school. Even now, after he has calmed a bit, Dale's reality testing is altered. The PMHNP considers that Dale is demonstrating: A. Symptoms of childhood schizophrenia B. A manic episode C. Brief psychotic disorder D. Intermittent explosive disorder Question 24 The PMHNP is providing counseling for the family of a 6-year-old girl who was recently adopted. This girl reportedly was removed from a home in which she was subjected to severe, long-term abuse in all forms: neglect, physical abuse, sexual abuse, malnutrition, and neglect of all medical care. Upon her rescue, which was incidental during a drug raid on the home, she was hospitalized for over 1 month for physical maintenance, nutrition, hydration, and treatment for a variety of infections, including sexually transmitted diseases. The adoptive family is very committed to providing a healthy environment and is very receptive to long-term individual and family therapy. The PMHNP discusses with the new parents and siblings that which of the following is most often linked to this type of history: A. Dissociative disorders B. Negative attachment C. Aggression toward siblings D. School refusal Question25 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? A. The parents' own emotional adjustments should be determined. B. The parents are usually more aware of symptoms than the child. C. The parents may prefer to speak with the PMHNP separately. D. The parents' upbringings are relevant to the child's diagnosis. Question 26 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. Question 27 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 Question 28 Having child and adolescent patients rate their feelings and moods on a scale of 1-10 is most effective in which age group? A. 18-months to 3 years B. 3 to 5 years C. 5 to 11 years D. 12 to 17 year Question 29 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. Question 30 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)? A. Crisis intervention and psychologic debriefing is most effective if it occurs within 24 hours of the event B. The focus of crisis intervention and psychologic debriefing is management of emotional reactions C. Psychoeducation is not typically a component of crisis intervention and psychologic debriefing D. No controlled studies support that crisis intervention and psychologic debriefing improves outcomes Question 31 Evaluation of psychiatric emergencies in children must include: A.A complete physical examination B. Psychiatric disorders in family members C. A comprehensive toxicology screen D. Interviews with teachers and noncustodial caretaker Question 32 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 D. Neuropsychiatric assessment Question 33 Brian is a 13-year-old boy who presents for care. He was initially brought in by his mother after a family friend suggested mental health evaluation. Brian has been suffering with a variety physical symptoms for the past 8 months, ever since school started. He has missed so much school that he is in danger of not advancing to the eighth grade. He persistently complains of headache, stomachache, nausea, and dizziness. He has even vomited on more than one occasion, so his mother knows something is ―really wrong.‖ The pediatrician has been unable to identify a cause of symptoms or offer any relief. During his interview, the PMHNP learns that this is Brian's first year in middle school. There are hundreds of students, and it is much larger than the intimate elementary school Brian attended from kindergarten through sixth grade. Brian is certain that all the students are making fun of him; he does not even go to the lunchroom to eat. He has stopped socializing with his small group of friends from elementary school because they have made friends among the other seventh graders. Brian says he wants to have friends, but he just gets nervous and he is sure they will all make fun of him. Brian enjoys ―hanging out‖ with his cousins, and they spent the week of spring break playing at his house. But, when it was time to go back to school, Brian was so nauseous he could not attend. Initial treatment for Brian should include: A. Psychiatric hospitalization B. Cognitive behavioral therapy C. Fluvoxamine (Luvox) 50 mg daily D. Family interventions Question 34 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 Question 35 Rose is a 13-year-old girl who is being evaluated as part of a family assessment; the primary patient is Rose’s 8-year-old brother who is demonstrating behavior of concern and is having a court-ordered evaluation. During the family assessment, it becomes apparent that Rose’s mother is very concerned that Rose is a tomboy. The mother, who is very elegant, is distressed byRose’s persistent “tomboy” behavior and worries that Rose might become a lesbian, which would be “unacceptable” to the family. More detailed evaluation of Rose reveals that she is experiencing some sexual reflection. She excels at sports and has always preferred rough and tumble play, but she doesn’t see anything wrong with that. She thinks she is sexually attracted to one of her female teachers, and sometimes fantasizes about her. Rose just began menstruating 3 months ago, and while she has had a boyfriend at school, she is not sexually active in any way; they have kissed a few times, and she likes it, but she has no plans to take it any further. Otherwise Rose seems well adjusted, worries about her brother, and dismisses her mother’s concerns as “silly.” Which of the following statements best characterizesRose? A. Rose should be evaluated for gender dysphoria as she meets the criteria of “strong preference for activities stereotypically engaged in by the other gender.” B. Rose is probably a lesbian and family therapy should include working with the mother to accept Rose’s sexual orientation. C. Rose may be a candidate for conversion therapy as her preferences are ambiguous at this point in her development. D. Rose does not appear to have concerns about her gender identity of sexuality and no further evaluation is indicated. Question 36 Learning disorders affect at least 5% of all school-aged children in the United States. Since 1975, Public Law 94-142 mandates that all states provide free, appropriate services to all children. Among the various types of learning disorders, the PMHNP knows that the overwhelming majority are: A. Reading disorders B. Mathematics disorders C. Disorders of written expression D. Learning disorders not otherwise specified (NOS) Question 37 The PMHNP has been trained in custody evaluations and is preparing to perform his first evaluation as a guardian ad litem. The case involves a 6-year-old boy and his 4-year-old sister. The parents are very angry and not able to talk or come to any agreements at all. Both parents want full custody and support from the other parent, both of whom are working professionals. After interviewing each party alone and then conducting a family interview, the PMHNP reviews all records made available, including the legal filings and petitions. There are no allegations of abuse or neglect or unsuitability from either parent; they just each want full custody. In addition to considering the best interests of the children, the PMHNP knows that the elements considered by the court will include all the following except the: A. Children’s current adjustment to home, school, and community B. Wishes of the children and parents C. Physical health of parents and children D. Parent’s degree of financial resources Question 38 Marion is a 17-year-old female who has been referred by her high school guidance counselor for evaluation. The counselor is concerned that Marion has an eating disorder because she has seen her in the bathroom on several occasions vomiting, but there is no other indicator of illness like fever or missing school days. When considering the diagnosis of anorexia nervosa, the PMHNP knows that all of the following must be present except: A. A voluntary, unhealthy degree of weight loss and maintenance B. An intense fear of becoming fat C. Some form of disorder of menstruation D. Symptoms present for at least 3 months Question 39 Ryan is a 6-year-old male who is being evaluated because his pediatrician is concerned that he demonstrates a marked inability to perform the daily motor skills consistent with what is expected at his age. At the age of 3 he was assessed due to delay in developmental milestones and was found to have an IQ of 68, consistent with mild mental retardation. When interpreting his motor coordination today, the PMHNP considers that: A. Deficits in coordination are consistent with mental retardation; mental retardation precludes a diagnosis of developmental coordination disorder B. This diagnosis is unlikely for Ryan as developmental coordination disorder is almost exclusively a diagnosis of females C. Gross motor problems are often associate with comorbid language disturbance D. Secondary peer relationship problems are common in children with developmental coordination disorder Question 40 Kelly is a 14-year-old female who has finally been referred for management of anorexia nervosa. She was diagnosed almost 1 year ago with the food-restricting subtype, but attempts to get her into psychiatric care were unsuccessful. She continues to be resistant but her caloric intake is now < 400 daily and she finally appears to be unable to sustain the supraphysiologic levels of exercise that she has maintained to try and “keep her weight down.” She is 5’2” tall and weighs 82 lbs., which is approximately 75% of ideal body weight for her height. Her vital signs are stable and surprisingly there are no profound laboratory or ECG abnormalities. When counseling Kelly and her parents about the recommended course of treatment, the PMHNP advises that Kelly will require: A. Intensive dynamic psychotherapy to alter eating behavior B. Hospitalization for controlled weight gain C. Pharmacotherapy with selective serotonin reuptake inhibitors D. Family therapy to include all members living in the home Question 41 The PMHNP is treating Pam, a 13-year-old female, for moderate-to-severe major depressive disorder. In addition to cognitive behavioral therapy, the PMHNP discusses with the patient and her father the plan to begin sertraline, 50 mg daily, then titrate the dose up when tolerance is established. Pam’s father has researched this medication and is concerned because he read about the risk of increased suicidal ideation. The most appropriate response is to tell Pam’s father that: A. His research is correct and they can use another drug class if he is more comfortable with that B. The risk is actually decreased when sertraline is used with cognitive behavioral therapy C. More recent research suggests that this is not accurate and that treatment actually decreases risk of suicide D. Sertraline is the only drug in its class indicated for adolescents and it does not carry this risk Question 42 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? A. The parents' own emotional adjustments should be determined. B. The parents are usually more aware of symptoms than the child. C. The parents may prefer to speak with the PMHNP separately. D. The parents' upbringings are relevant to the child's diagnosis. Question 43 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 Question 44 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 Question 45 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 Question 46 Which of the following is not a true statement with respect to theorized etiologies of ADHD? A. Psychosocial factors do not appear to contribute to the development of ADHD. B. Some literature suggests that prenatal exposure to winter infection during the first trimester of pregnancy leads to ADHD C. Biological parents of children with ADHD have a higher incidence of the disorder than adoptive parents D. Overall, no clear-cut evidence supports a single neurotransmitter in the development of ADHD Question 47 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: A. Does not offer flexibility in understanding the evolution of the problem B. Frequently deemphasizes the influence of environmental factors C. May not systematically cover all psychiatric diagnostic categories D. Creates a dialogue in which patients cannot give subjective responses Question 48 Trauma-focused cognitive behavior therapy is a CBT approach characterized by 10-16 sessions comprised of four components: (1) psychoeducation, (2) stress inoculation, (3) gradual exposure, and (4) cognitive reprocessing. This is a management strategy for posttraumatic stress disorder (PTSD) that is: A. Most effective when paired with eye movement desensitization and reprocessing (EMDR) B. Considered by experts to be the first-line management approach for treatment of PTSD symptoms C. Very effective in individuals but generally not recommended for group treatment, e.g., school-based traumas D. Gaining widespread acceptance as a first-line management strategy for other forms of anxiety disorders Question 49 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 Question 50 Justin is a 3½ -year-old boy who comes in with his mother. She is concerned that he has obsessive-compulsive disorder (OCD). Justin's mother says that her husband has struggled with OCD all his life; he was first diagnosed when he was 11 years old thanks to an alert teacher who suggested mental health care. Justin's mother has been very proactive in studying genetic risk, and she knows that Justin is at significantly increased risk due to the early-onset in his father. Which of the following behaviors by Justin would be most consistent with OCD? A. Clear social difficulties in addition to an apparently unusual need for cleanliness and order in his bedroom B. Refusal to go to bed without his blue stuffed elephant; this began over a year ago and is getting progressively worse C. Insistence upon precise placement of plate, cup, utensils and food on plate when eating; when he cannot achieve this, he will not eat D. A concomitant diagnosis of ADHD for which the family is currently in behavioral therapy Question 51 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 Question 52 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: A. Separation anxiety B. Social anxiety C. Generalized anxiety D. Specific phobia Question 53 Management of a child who has a pattern of fire-setting behavior must include: A. Combination therapies that include medication with an SSRI B. Parental counseling that the child should never be allowed home alone C. Inpatient admission for intensive individual and group therapy D. Behavioral interventions characterized by negative reinforcemen Question 54 During the initial interview with Lorraine, a 13-year-old girl being evaluated for oppositional defiant disorder (ODD), the PMHNP does not appreciate any of the behavior that has been reported by Lorraine's mother and teachers. Lorraine is found to be well groomed, appropriate in her interaction, and says she is not sure why she is there. Lorraine says that her parents and teachers say that she is always arguing and breaking the rules, but she does not really understand what the problem is. The PMHNP notes that: A. He will need to have more information from adults who are not in frequent contact with Lorraine B. This is common, as the symptoms are often only expressed to adults who know the child well. C. ODD is episodic, and it is not unusual to have long symptom-free periods; a normal interview does not preclude diagnosis D. The diagnosis should be reconsidered as it is almost impossible to have a diagnosis of ODD without the patient's awareness of symptoms Question 55 When treating anxiety disorders in young children, cognitive behavioral therapy (CBT) is preferred as initial treatment if the child is able to function sufficiently to engage in daily activities while in treatment. Which of the following therapies is appropriate for those children too young to engage in traditional CBT? A. Selective serotonin reuptake inhibitors (SSRI) B. SSRI in combination with CBT C. Coaching Approach behavior and Leading by Modeling (CALM) D. CALM in combination with a first-generation antihistamine Question 56 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: A. Their own fears and anxieties B. Psychotic episodes they have experienced C. The chronology of symptom presentation D. Episodes of mood extremes Question 57 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 Question 58 Adam is a 26-month-old boy referred by his pediatrician for evaluation of speech delay. He has not spoken any intelligible words. Adam is an only child, and the parents deny any contributory medical history. Adam was delivered at 38 weeks 5 days' gestation without complication. At 5 weeks of age he developed respiratory failure due to respiratory syncytial virus (RSV) and was hospitalized on a ventilator for several days; since then, the parents report only the occasional upper respiratory virus. They report that Adam is a ―really good‖ child and will often entertain himself for periods of time with his building blocks; rarely he will have a ―temper tantrum.‖ The parents confirm that Adam does not speak any recognizable words. While he does make sounds, his parents admit that he does not appear to be trying to communicate with them. When considering a diagnosis of autism spectrum disorder (ASD), the PMNHP would expect further history and examination to reveal: A. The presence of imaginary play B. A failed hearing test C. Exaggerated response to minor injury D. Notable decrease in attachment behaviors Question 59 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 Question 60 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 dail Question 61 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 Question 62 The PMHNP is evaluating his data for the assessment of Eric, a 23-month-old male who was referred because he is having nightmares to the extent that most nights he is waking up family members with his crying and screaming. In addition to the clinical interview with the parents and patient, developmental assessment, and standardized tools, the assessment should include: A. Review of a video recording of a nightmare event and Eric’s immediate response B. Age-appropriate interview, e.g., ―If you had three wishes, what would they be?‖ C. Observation of Eric in a playroom where he is unaware that he is being watched D. Partially open-ended questions that provide some focus but allow expression of feeling Question 63 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 Question 64 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 Question 65 When treating anxiety disorders in young children, cognitive behavioral therapy (CBT) is preferred as initial treatment if the child is able to function sufficiently to engage in daily activities while in treatment. Which of the following therapies is appropriate for those children too young to engage in traditional CBT? A. Selective serotonin reuptake inhibitors (SSRI) B. SSRI in combination with CBT C. Coaching Approach behavior and Leading by Modeling (CALM) D. CALM in combination with a first-generation antihistamine Question 66 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 Question 67 Nate is a 9-year-old boy who presents for a follow-up visit. He was diagnosed with ADHD 4 months ago and started on methylphenidate 5 mg b.i.d. At a 1-month follow-up his mother reported that he was not really demonstrating any improvement of symptoms, so he was increased to 10 mg b.i.d. He has been on this dose for 1 month. Nate reports that sometimes he doesn’t feel so great; he gets a stomach ache sometimes and a few weeks ago he felt ―dizzy.‖ His vital signs are within normal limits. Mom says that on this dose his teacher says his behavior in school is much improved, and she notices that at home he seems more focused and is able to do his homework and chores. The appropriate action with regard to his medications at this point would be to: Discuss with Mom nonstimulant options such as atomoxetine Reduce his dose back to 5 mg b.i.d. until adverse effects resolve Add 25 mg of diphenhydramine to his daily regimen at h.s. Continue the current plan of care and reassess in 1 month Question 68 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 Question 69 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 Question 70 Sarah is a 10-year-old patient who has been diagnosed with oppositional defiant disorder. While discussing the diagnosis, course and prognosis, and treatment strategies with Sarah’s mother, the PMHNP emphasizes that successful management of oppositional defiant disorder (ODD) must include: A. Parent training B. Pharmacotherapy C. Time out D. Conflict avoidance Question 71 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: A. Physical bullying has the most dangerous outcomes B. Bullying is more common in boys than girls C. Victims often develop alcohol abuse problems D. Verbal bullying is the most common form Question 72 The PMHNP is preparing an educational program for primary care providers about child abuse awareness. The goal of the program is to increase the understanding of primary care providers regarding risk factors for child abuse so that at-risk families may be identified and primary preventive strategies implemented before any harm occurs to children. The program emphasizes risk factors for child maltreatment to include all of the following except: A. Single-parent families B. Low parental education C. Parental substance abuse D. Firstborn child in the family Question 73 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) Question 74 Susan is a 10-year-old girl who has been referred by her pediatrician for mental health evaluation due to a persistent collection of somatic symptoms for which there is no apparent organic cause. For the last 2 months Susan has been increasingly distraught at the prospect of leaving home. This has become very apparent since the start of the school year. She often develops stomachaches and headaches when it is time to go to school. Lately she does not want to go to bed unless her mother remains upstairs. The PMHNP considers a diagnosis of: A. Separation anxiety disorder B. Social anxiety disorder C. Generalized anxiety disorder D. Social phobia disorder Question 75 Kristina is a 17-year-old female who was encouraged to care by her parents because they have been worried about her. She has always been very healthy, happy, and active in school and sports. Her boyfriend of three years broke up with her last fall, right before he left for college. Since then she has lost all interest in her friends and school. Her parents say that she doesn’t do anything after school except go to her room. She has lost 16 pounds in the last 9 months. During the second session with the PMHNP, Kristina insists that her parents are overreacting, that she is doing OK in school and is eating just fine. She says of course she was sad that her boyfriend broke up with her, but she has gotten over it and moved on. During this session, the PMNHP appreciates that Kristina’s clothes are clearly too big for her, her eyes fill up with tears whenever her boyfriend is mentioned, and she does not seem engaged in the interview. While considering her assessment, the PMHNP recognizes that: A. The absence of a remote history of psychiatric disease makes a true psychiatric diagnosis unlikely B. The PMHNP must prioritize Kristina’s subjective report versus her parents’ report C. A standardized assessment tool such as the Patient Health Questionnaire (PHQ)-9 will be required for diagnosis D. The objective signs evident in Kristina’s examination are more compelling than her perspective on symptoms

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