Walden NURS6660 final exam

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Walden NURS6660 final exam

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.            Hypersexuality and inattention

Margaret is a 14-year-old girl being seen in follow-up for major depressive disorder. She has been on a therapeutic dose of a selective serotonin reuptake inhibitor (SSRI) for 3 months and has still failed to achieve remission. Consistent with the Texas Children’s Medication Algorithm Project (TMAP), the next action should be to:

Ms. Stevenson is a 21-year-old woman who brings her 3-week-old infant to the PMHNP for an “emergency” evaluation. Ms. Stevenson has a 2-year-old who was diagnosed with rumination disorder when he was 10 months old and had to be hospitalized for tube feedings while the family started treatment. Ms. Stevenson is worried now because her new baby vomits every time he eats; she is afraid he has the same thing. The PMHNP counsels Ms. Stevenson that:

A.            Rumination does not run in families and it is unlikely that the new baby has this rare disorder.

B.            The baby needs to be evaluated for pyloric stenosis and should be referred to his pediatrician.

C.            The family will likely benefit from the same psychotherapeutic interventions that were used with the older child.

D.            They will begin with a nutritional assessment to see if the new baby needs a feeding tube.

Justin is a 12-year-old male who was recently diagnosed with schizophrenia. He was quickly placed into a highly regarded assessment and treatment program and began pharmacotherapy and cognitive behavioral therapy. His parents have had a difficult time with the diagnosis as Justin has always been very healthy, a good school performer, and has never had any developmental concerns or delays. However, they are very supportive and committed to his recovery. Justin has been on an atypical antipsychotic for 1 month with no intolerable adverse effects. When counseling Justin’s parents about the prognosis, the PMHNP advises the parents that which of the following is more correlated with good outcomes in patients like Justin?

A.            His age at the time of diagnosis

B.            The absence of family history

C.            Justin’s level of function before diagnosis

D.            Tolerance of antipsychotic medication

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

The PMHNP is developing a brief informational pamphlet on gender dysphoria to distribute at a local mental health awareness event for the general public. The “basic facts” section of the pamphlet correctly states that:

A.            The majority of children who demonstrate nonconforming gender behavior in childhood grow up to be transgender adults

B.            The ratio of gender dysphoria in adolescent boys and girls is equal

C.            A genetic basis for gender dysphoria has been identified

D.            Diagnostic criteria for gender dysphoria is the same across the lifespan

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 attachment

The leading cause of death in youths living in juvenile residential facilities is:

A.            Suicide

B.            Accident

C.            Homicide

D.            Illness

American Adoption Congress represents the shared interests of the adoption tria

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.

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 identify with her physiologic gender

B.            Does not have a clear sense of gender identity and may be a candidate for reparative therapy to correct her gender identity issues

C.            Is a transgender female who identifies as lesbian

D.            Is a heterosexual male with transvestic disorder

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

Cyclothymic disorder I forgot to put the question, but it is on this disorder

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 aren’t 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

B.            Hallucinations are significantly more predictive of schizophrenia than delusions in young children

C.            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 very unlikely

Susan is a 12-year-old girl who is referred for psychiatric evaluation because she is having social problems at school. She is always picked last for teams in physical education, and she is becoming exceedingly depressed about the lack of social interaction at school. A detailed history reveals that Susan has always had delayed developmental milestones, including delayed sitting without support and transferring objects hand to hand. She did not walk until she was 20 months old, and for years afterward had persistent issues with falling. Now, at age 12, she is having trouble with her handwriting. The PMHNP considers which of the following diagnoses as most likely?

A.            Disorder of written expression

B.            Autism spectrum disorder

C.            Developmental coordination disorder

D.            Learning disorder not otherwise specified

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

C.            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

Cameron is a 7-year-old boy who has been diagnosed with ADHD and started on psychostimulants. Two months later there has been no meaningful improvement of symptoms, and he is referred from primary care to a PMHNP. While reviewing his records, the PMHNP notes that Cameron has been living with his aunt and uncle and their four children since the death of his mother 6 months ago. Cameron, who reportedly was always a happy and well-adjusted only child, developed symptoms shortly after these major life changes. His symptoms were characterized primarily by temper tantrums and an inability to sit still. He is not functioning well in school and is having repeated stomachaches and headaches. The PMHNP considers that the most appropriate action would be to stop the psychostimulant and assess Cameron for:

A.            Bipolar I disorder

B.            Agitated depression

C.            Dysthymic disorder

D.            Cyclothymic disorder

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

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

emediation therapy for her reading disorder.

Debbie is a 10-year-old female who has been referred to remediation therapy for her reading disorder. While designing her treatment program, the PMHNP knows that the most current strategies are characterized by:

A.            An Individual Education Program (IEP) provided by the public school system

B.            Continuous practice with flash cards, workbooks, and computer games

C.            Focusing the child’s attention to the connections between speech sounds and spelling

D.            Direct practice in spelling and sentence writing and review of grammatical rules

Roshan is a fourth grader who is being evaluated for poor scholastic performance in mathematics. He has always been a happy, healthy child, has socialized with friends at school, and presents no behavioral concerns at home. However, his math performance has always been below the average for his grade, and now he is performing so far below his peers that he is really beginning to be upset about it. While being evaluated for a learning disorder, the PMHNP appreciates that Roshan has had a marked deficit in his ability to recognize and understand symbols and order clusters of numbers. This suggests a deficit in:

A.            Linguistic skills

B.            Perceptual skills

C.            Mathematic skills

D.            Attention skills

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.

C.            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.

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 includes which of the following pieces of information?

A.            Schizophrenia is up to eight times more prevalent in first-degree relatives as compared to the general population.

B.            Schizophrenia has been isolated to chromosome number 5 and antenatal testing is available to predict genetic predisposition of the fetus.

C.            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.

Donna is a 16-year-old transgender female who has been through extensive individual and family counseling and is ready to start hormone therapy with estrogen, progesterone, and testosterone-blocking agents. When counseling her specifically about the risks, benefits, and required monitoring of hormonal therapy, the PMHNP advises Donna that:

A.            Her voice will become more consistent with the female gender

B.            She will need routine lipid and diabetes screening

C.            Sterility is a probable consequence of hormone therapy

D.            Worsening of acne is common in the first year of treatment

The PMHNP suspects that Wesley, an 8-year-old male, has a reading disorder. In kindergarten his teacher documented some suspicion for a disorder, but throughout first grade and now into second grade, he is clearly functioning below expected levels.. He becomes increasingly anxious when asked to read in school. Which aspect of Wesley’s history would support the risk for this diagnosis?

A.            Visual perceptual deficits

B.            Social anxiety disorder

C.            Inadequate schooling

D.            Attention deficit hyperactivity disorder

Lamictal weight gain. Forgot this question as well, know which bipolar treatment isn’t associated with weight gain Lamictal, Zyprexa, lithium and risperdone

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

Rumination is a feeding disorder most commonly seen in infants, but it can occur at any point in the lifespan. Characteristic findings in infants include:

A.            Resultant soothing

B.            Comorbid hiatal hernia

C.            Failure to thrive

D.            Onset at 4–6 weeks of age

When counseling the parents of an intersex neonate, the PMHNP recognizes that the current standard of care is to counsel toward:

A.            Male-to-female surgical procedures

B.            Flexible sex rearing

C.            An early and consistent decision of the child’s gender

D.            Hormone augmentation of chromosomal gender

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

he 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:

A.            Younger children adopted from foster care settings have the best outcomes

B.            Children adopted from abuse and neglect situations have better psychological adaptation than those adopted as newborns

C.            Transracial adoptions have demonstrated greater disruptions as compared to same-race adoptions

D.            Adoptions into families as an only child are more successful than those into families with biological children

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 by Rose’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 characterizes Rose?

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.

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

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 improve

B.            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

Bipolar I disorder is being diagnosed with increasing frequency in prepubertal children. Which of the following is a true statement with respect to this trend?

A.            Better awareness and screening practices promote earlier diagnosis and management.

B.            The diagnosis is controversial because few children this age exhibit discrete mood cycles.

C.            The majority of children diagnosed with bipolar I have a history of attention deficit hyperactivity disorder.

D.            Prepubertal children with bipolar I are extremely sensitive to mood stabilizers.

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

The PMHNP is working with the parents of a 13-month-old male who is diagnosed with avoidant/restrictive food intake disorder. The toddler will eat, but he seems to tire both physically and emotionally very quickly and is easily distracted; once distracted, he will not return to the meal. His weight trajectory has dropped and he has gone from a weight of 60 percentile for age/height to 10 percentile for age/height. As part of the transactional plan of care, the parents will be encouraged to:

A.            Allow the child to determine the eating schedule, and feed him whenever he appears hungry

B.            Offer high calorie liquid supplements between scheduled meals

C.            Present playful stimuli during and immediately after meals

D.            Give attention and praise to positive eating beha

All the following are true with respect to making a diagnosis of major depressive disorder in children except:

A.            There must be a change from previous level of functioning.

B.            There must be social or academic impairment.

C.            There must be somatic or psychomotor complaints.

mean length of major depressive episode in adolescents is 4 months

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

Which of the following is a true statement with respect to developmental coordination disorder?

A.            The majority of children with this disorder do not have a history of significant developmental milestone delay.

B.            The clumsiness of developmental disorder generally persists into adolescence and adulthood.

C.            Most successful treatment strategies involve integrative physical education to include the peer group in team sports.

D.            Neurologic examination is very similar to patients with neuromuscular disease.

The PMHNP is preparing a presentation for a conference of pediatric primary care providers. The topic of the presentation is early identification and referral of developmental coordination disorder. When outlining high-risk populations, the PMHNP discusses that statistically there is a higher incidence of occurrence in children with all of the following except:

A.            Speech disorders

B.            Learning disorders

C.            Attention deficit hyperactivity disorder (ADHD)

D.            Oppositional defiant disorder (ODD)

 

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