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Course NURS-6660N-8,PMH NP Role I:
Child.
Test Final Exam - Week 11
Started 11/6/19 4:12 PM
Submitted 11/6/19 5:31 PM
Due Date 11/11/19 1:59 AM
Status Completed
Attempt Score 71 out of 75 points 3
Time Elapsed 1 hour, 18 minutes out of 2
hours
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Displayed
Submitted Answers
Question 1
1 out of 1 points
Conventional antipsychotics are not first-line interventions in early-onset schizophrenia
due to the risk of dystonic reactions. However, when children are not responsive to first-
line therapy with atypical antipsychotics, which of the following is the most appropriate
conventional choice?
Selected
Answer:
D.
Chlorpromazi
ne
Question 2
1 out of 1 points
The therapeutic outcomes for children with disorders of written expression are most
favorable when they are characterized by:
Selected
Answer:
Intensive, continuous administration of individually tailored, one-on-one
expressive and3creative writing3therapy
Question 3
1 out of 1 points
Linda is a 5-year-old girl who has persistent pica; she was finally referred for care when
her3kindergarten3teacher became alarmed by her eating of potentially toxic nonfood
substances. 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 didn’t eat anything dangerous.
Linda’s mother must work two jobs and essentially did not bother to pursue Linda’s
unusual symptom because it didn’t seem unsafe. While discussing3management
strategies3with Linda’s mother, the PMHNP counsels that the most rapidly successful
treatment strategy appears to be:
Selected A.
Answer: Aversion
therapy
Question 4
0 out of 1 points
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:
Selected
Answer:
C.
Failure to
thrive
Question 5
1 out of 1 points
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:
Selected
Answer:
C.
Is a transgender female who identifies as
lesbian
Question 6
1 out of 1 points
All the following are true with respect to making a3diagnosis3of major depressive disorder
in children except:
Selected
Answer:
C.
There must be somatic or psychomotor
complaints.
Question 7
1 out of 1 points
Donna is a 16-year-old transgender female who has been through extensive individual
and family counseling and is ready to start3hormone therapy3with 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:
Selected
Answer:
C.
Sterility is a probable consequence
of3hormone therapy
Question 8
1 out of 1 points
The leading cause of death in youths living in juvenile residential facilities is:
Selected
Answer:
A.
Suicid
e
Question 9
1 out of 1 points
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:
Selected
Answer:
C.
Higher socioeconomic status and lifetime psychosis are predictors of
more rapid cycling in early-onset bipolar disorder
Question 10
1 out of 1 points
Tiana is a 10-year-old girl who is being referred for evaluation because her school
performance is appreciably below what is expected at her age. Historically she has been
a very happy child, likes school, and looks forward to going. However, over the last
several months her teacher reports that she is much slower than her peers in reading,
and she appears to be upset and withdrawn when asked to read in class. The PMHNP
would expect additional report from the teacher to include all the following except:
Selected
Answer:
A.
Inability to copy correctly from a
printed text
Question 11
1 out of 1 points
Which of the following statements best characterized the treatment course and
progression of bulimia nervosa?
Selected
Answer:
A.
Cognitive behavioral therapy is considered the benchmark, first-
line treatment.
Question 12
1 out of 1 points
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
ideal3body weight3for 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:
Selected
Answer:
B.
Hospitalization for controlled
weight gain
Question 13
1 out of 1 points
In which demographic is depression twice as prevalent in girls as compared to boys?
Selected
Answer:
C.
Adolescen
ts
Question 14
1 out of 1 points
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:
Selected
Answer:
C.
Focusing the child’s attention to the connections between speech
sounds and spelling
Question 15
1 out of 1 points
Which of the following symptom clusters is most likely in a 16-year-old male with major
depressive disorder?
Selected
Answer:
D.
Pervasive anhedonia, hopelessness, and severe psychomotor
retardation
Question 16
1 out of 1 points
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
children?
Selected
Answer:
A.
Prepubertal children having a depressive episode secrete significantly
more growth hormone during sleep than nondepressed children.
Question 17
1 out of 1 points
Jared is a 6-year-old boy who comes to the PMHNP for an evaluation with his father. The
father reports that he is worried about Jared because he has had problems fitting in at
school ever since he started kindergarten. He does not have any friends at school and
does not seem to know how to play with others. Dad reports that Jared has never been
“very talkative” and sometimes switches from one topic to another without any reason.
When considering early-onset schizophrenia, the PMHNP recognizes that which of the
following must be present?
Selected
Answer:
B.
Deteriorating function over the last several
months
Question 18
1 out of 1 points
Learning disorders affect at least 5% of all school-aged children in the United States.
Since 1975,3Public Law394-142 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:
Selected
Answer:
A.
Reading
disorders
Question 19
1 out of 1 points
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:
Selected
Answer:
B.
Poverty of speech
content
Question 20
1 out of 1 points
The PMHNP is working with rural3primary care3providers 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:
Selected
Answer:
D.
Inadequate emotional
attachment
Question 21
1 out of 1 points
Which of the following is a true statement with respect to avoidant/restrictive food intake
disorder?
Selected
Answer:
B.
Approximately 70% of infants who persistently refuse food continue to
have some eating problems during childhood.
Question 22
1 out of 1 points
Regarding pediatric suicide, which of the following is a true statement?
Selected
Answer:
A.
Worldwide, suicide very rarely occurs in children who have not
reached puberty.
Question 23
1 out of 1 points
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 in3foster care3vs. one who lives in an orphanage. While counseling
this couple, the PMHNP advises them that:
Selected
Answer:
A.
Younger children adopted from3foster care3settings have the
best outcomes
Question 24
1 out of 1 points
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:
Selected
Answer:
C.
More recent research suggests that this is not accurate and that
treatment actually decreases risk of suicide
Question 25
1 out of 1 points
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?
Selected
Answer:
A.
Alleviating negative
symptoms
Question 26
1 out of 1 points
While counseling the parents of Joshua, a 9-year-old patient with developmental
coordination disorder, the PMHNP advised that the treatment will include:
Selected
Answer:
A.
Modified physical
education
Question 27
1 out of 1 points
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?
Selected
Answer:
D.
Stress-
diathesis
Question 28
1 out of 1 points
Standardized instructional programs used in the management of reading disorders
include all the following except:
Selected
Answer:
D.
Woodcock-Johnson Psychoeducational
Battery
Question 29
1 out of 1 points
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’s3history3would support the risk for this diagnosis?
Selected
Answer:
D.
Attention deficit hyperactivity
disorder
Question 30
1 out of 1 points
When counseling the parents of an intersex neonate, the PMHNP recognizes that the
current standard of care is to counsel toward:
Selected
Answer:
B.
Flexible sex
rearing
Question 31
1 out of 1 points
Jessica is a 26-month-old female who is being evaluated because she will not eat. Her
parents report that she just flat out will not eat her3meals. Her mother says that she has
followed all the pediatrician’s suggestions: she has eliminated any snacks or drinks
between meals, and she has offered a variety of foods, including those that Jessica
seemed to enjoy previously. Jessica is not sick; has no problems with vomiting or
elimination abnormalities. Jessica’s parent say that her pediatrician is not concerned, but
they are not comfortable with what appears to be an almost complete absence of food
intake. While considering a diagnosis of avoidant food intake disorder the PMHNP knows
that any of the following would fulfill the diagnostic criteria except:
Selected
Answer:
A.
An irritable, apathetic, or anxious
affect
Question 32
1 out of 1 points
Rose is a 13-year-old girl who is being evaluated as part of a family assessment;
the3primary3patient 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?
Selected
Answer:
D.
Rose does not appear to have concerns about her gender identity of
sexuality and no further evaluation is indicated.
Question 33
1 out of 1 points
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 infoster careas 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:
Selected
Answer:
C.
The history and reported symptoms are typical of depressive disorder
in young children
Question 34
0 out of 1 points
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:
Selected
Answer:
C.
The family will likely benefit from the same psychotherapeutic
interventions that were used with the older child.
Question 35
1 out of 1 points
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?
Selected
Answer:
A.
The PMHNP should not be concerned with consent for disclosure when
child abuse or maltreatment has occurred.
Question 36
1 out of 1 points
Which of the following is a true statement with respect to developmental coordination
disorder?
Selected
Answer:
B.
The clumsiness of developmental disorder generally persists into
adolescence and adulthood.
Question 37
1 out of 1 points
The PMHNP is preparing a presentation for a conference of pediatric3primary
care3providers. 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:
Selected
Answer:
D.
Oppositional defiant disorder
(ODD)
Question 38
1 out of 1 points
A 14-year-old boy was presented to care by his parents because of progressive social
withdrawal.Upon completionof the patient interview, mental status exam, and family
assessment, review of all information reveals that for the past 15 months Bruce has been
progressively “moody.” His parents say that he has become so irritable that his little brother
and sister are afraid to talk to him anymore. Additionally, he has become socially withdrawn,
now not even wanting to go to school. Bruce says he is tired all the time and just doesn’t feel
like doing anything. He often does not complete homework assignments. When considering
a diagnosis of dysthymic disorder, the PMHNP knows that which other history finding must
be present?
Selected
Answer:
B.
Symptoms not resolved for more than 2 months
at a time
Question 39
1 out of 1 points
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:
Selected
Answer:
C.
20 to 40% of adolescents who have major depressive disorder will
develop bipolar I within 5 years
Question 40
1 out of 1 points
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:
Selected
Answer:
B.
Lowered serotonin activity is seen in the brains of patients with
bulimia nervosa.
Question 41
1 out of 1 points
Mrs. Henderson is a 24-year-old mother of 4 children under the age off 5. She has
developed a trust relationship with the PMNHP after successful evaluation and
management of ADHD in her oldest child. She now brings in her 3-year-old for an
evaluation because she keeps eating things she finds within reach – paper, dirt, and one
day, the mother found this child eating from the cat litter box. The mother says the child
is up to date on her vaccines but she has not mentioned this problem to the pediatrician.
The PMHNP knows that immediate assessment must include:
Selected
Answer:
B.
Laboratory assessment of hemogram, iron, zinc, and
lead levels
Question 42
1 out of 1 points
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?
Selected
Answer:
B.
Physical restlessness and poor
judgment
Question 43
1 out of 1 points
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?
Selected
Answer:
B.
The diagnosis is controversial because few children this age exhibit
discrete mood cycles.
Question 44
1 out of 1 points
Marion is a 17-year-old female who has been referred by her high school3guidance
counselor3for 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:
Selected
Answer:
C.
Some form of disorder of
menstruation
Question 45
1 out of 1 points
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?
Selected
Answer:
C.
Developmental coordination
disorder
Question 46
1 out of 1 points
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?
Selected
Answer:
C.
Delayed motor milestones and language
acquisition
Question 47
0 out of 0 points
When completing this exam, did you comply with Walden University’s Code of Conduct
including the expectations for academic integrity?
Selected
Answer:
Ye
s
Question 48
1 out of 1 points
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 school work. 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:
Selected
Answer:
B.
Pharmacotherapy for
bipolar I
Question 49
1 out of 1 points
Christine is a 9-year-old female who presents for care after having been placed in the
local3foster care3system. 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:
Selected
Answer:
D.
Attachment
disorder3
Question 50
1 out of 1 points
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:
Selected
Answer:
A.
Taper the fluoxetine off and see if these
symptoms improve
Question 51
1 out of 1 points
While not currently indicated for the treatment of early-onset bipolar disorder, which of
the following medications has demonstrated utility in clinical trials without any
associated weight change, rash, or other adverse events?
Selected
Answer:
A.
Lamotrigi
ne
Question 52
1 out of 1 points
In the juvenile justice system, the difference between3delinquent acts3and3status
offenses3is:3
Selected
Answer:
B.
Delinquent acts are ordinary crimes committed by juveniles; status
offenses would not be crimes if committed by an adult
Question 53
1 out of 1 points
Cameron is a 7-year-old boy who has been diagnosed with ADHD and started on
psychostimulants.3Two months3later 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:
Selected
Answer:
B.
Agitated
depression
Question 54
1 out of 1 points
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:
Selected
Answer:
D.
Parent’s degree of3financial
resources
Question 55
1 out of 1 points
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 intolerable3adverse 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?
Selected
Answer:
C.
Justin’s3level3of function before
diagnosis
Question 56
1 out of 1 points
There are several physiologic abnormalities that may result in ambiguous genitalia
and/or an unclear sense of gender identity leading to gender dysphoria. When an
adolescent female is found to have cryptorchid testes, this indicates a condition known
as:
Selected
Answer:
B.
Androgen insensitivity
syndrome
Question 57
1 out of 1 points
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:
Selected
Answer:
D.
Secondary peer relationship problems are common in children with
developmental coordination disorder
Question 58
0 out of 1 points
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
to3family history3and 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?
Selected
Answer:
D.
Environment is at least as important as genetics with respect to
expression of schizophrenic symptoms.
Question 59
1 out of 1 points
The American Adoption Congress represents the shared interests of the adoption triad, a
phrase used to represent:
Selected
Answer:
B.
Birth parents,3adoptive parents, and
adoptees
Question 60
1 out of 1 points
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:
Selected
Answer:
B.
Perceptual
skills
Question 61
1 out of 1 points
The PMHNP is having a family meeting with 8-year-old Hunter and his father and
stepmother to discuss the results of his mathematics assessment. Analysis of his
performance on the KeyMath Diagnostic Arithmetic Test reveals a performance markedly
below what is expected for his age. Hunter’s mother feels certain that his poor
performance is a result of poor education; apparently Hunter’s mother was
homeschooling him, but subsequently she was found to be so neglectful of all of his
needs that his father and stepmother were given full custody. When discussing the
course and prognosis for Hunter’s mathematics disorder, the PMHNP advises that:
Selected
Answer:
B.
Mathematics disorders are not stable over time, and early intervention
may lead to improvement of skills
Question 62
1 out of 1 points
When considering a diagnosis of developmental coordination disorder, the PMHNP knows
that the diagnosis may be associated with:
Selected
Answer:
C.
Soft neurologic signs on physical examination such as slight reflex
abnormalities
Question 63
0 out of 1 points
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:
Selected
Answer:
A.
Change to an
SNRI
Question 64
1 out of 1 points
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:
Selected
Answer:
B.
Hallucinations are significantly more predictive of schizophrenia than
delusions in young children
Question 65
1 out of 1 points
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
not3return3to 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:
Selected
Answer:
D.
Give attention and praise to positive eating
behaviors
Question 66
1 out of 1 points
Children with gender dysphoria typically have higher rates of all the following except:
Selected
Answer:
D.
Eating
disorder
Question 67
1 out of 1 points
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?
Selected
Answer:
A.
Complete3blood count, thyroid function tests, and
serum calcium
Question 68
1 out of 1 points
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:
Selected
Answer:
D.
Habit-reversal
therapies
Question 69
1 out of 1 points
The difference between hormonal management of transgender adolescents from adults is
that which of the following has no role in adult management?
Selected
Answer:
B.
Gonadotropin-releasing
hormone
Question 70
1 out of 1 points
Eileen is a 23-month-old girl who is being evaluated for autism3spectrum3disorder
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 peeling
off 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?
Selected
Answer:
C.
The pattern of
eating
Question 71
1 out of 1 points
Rose is a 12-year-old female who is being evaluated for declining school performance
and an increasing tendency to try to avoid going to school. Historically she has been an
average student, although she has particularly struggled with writing exercises and has
actually failed assignments this year. She consistently ignores rules of grammar, and her
teacher says that her writing submissions look as if they were written by a much younger
child. The PMHNP knows that the initial evaluation of Rose must include all the following
except:
Selected
Answer:
C.
The Test of Early Written
Language
Question 72
1 out of 1 points
Kelly is a 13-year-old female who is being evaluated at the recommendation of her
seventh-grade teacher. This is her first year in junior high and her teacher is concerned
over what appears to be marked social isolation. She does not appear to have any close
friends or social contacts. She eats lunch with the girl who lives next door to her, but
even that is initiated more by the other child. Her teacher also reported that Kelly seems
to have certain unusual preoccupations, such a preoccupation with religions despite the
fact that her family has never been religious. During the examination, Kelly clearly
demonstrates some odd behavior. When talking about her family, she does not express
any emotion. She doesn’t laugh at anything and appears withdrawn, yet she will answer
questions asked of her. The PMHNP, after completing his evaluation, considers a
diagnosis of schizotypal disorder because review of Kelly’s assessment reveals:
Selected
Answer:
A.
The absence of any overt psychotic symptoms in
the history
Question 73
1 out of 1 points
The PMHNP is developing a brief informational pamphlet on gender dysphoria to
distribute at a local3mental health3awareness event for the general public. The “basic
facts” section of the pamphlet correctly states that:
Selected
Answer:
B.
The ratio of gender dysphoria in adolescent boys and
girls is equal
Question 74
1 out of 1 points
Early-onset schizophrenia is quite rare as compared to adolescent and adult onset.
Certain features are unique to early-onset schizophrenia and include all 3the following
except:
Selected
Answer:
D.
Better long-term outcomes with early
intervention
Question 75
1 out of 1 points
All of the following are proposed etiologies of pica except:
Selected
Answer:
D.
Autism spectrum
disorder
Question 76
1 out of 1 points
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 didn’t help. In considering a diagnosis of cyclothymic
disorder, the PMHNP considers that:
Selected
Answer:
A.
Symptoms need to be present for at
least 1 year
