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Review Test Submission: Midterm Exam - Week 6
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Course NURS-6660N-11,PMH NP Role I: Child.2019 Spring Qtr 02/25-05/19-PT27
Test Midterm Exam - Week 6
Started 4/7/19 9:38 AM
Submitted 4/7/19 11:11 AM
Due Date 4/8/19 1:59 AM
Status Completed
Attempt Score 71 out of 75 points 2
Time Elapsed 1 hour, 32 minutes out of 2 hours
Results Displayed Submitted Answers
Question 1
1 out of 1 points
Psychiatric assessment of children and adolescents is best achieved by a combination of tools and
techniques best suited to the child’s age and developmental stage. When interviewing a 10-year-old,
the PMHNP may have the best success by having the patient:
Selected Answer: C.
Draw family members and peers
Question 2
1 out of 1 points
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:
Selected Answer: A.
Ask the parents to step out and interview Kevin privately
Question 3
1 out of 1 points
Evaluation of psychiatric emergencies in children must include:
Selected
Answer:
B.
Psychiatric disorders in family members
Question 4
1 out of 1 points
With respect to psychiatric assessment, the PMNHP knows that in terms of confidentiality:
Selected
Answer:
B.
Whenever there is a suspicion of neglect or abuse, the appropriate state agency
must be notified.
Question 5
1 out of 1 points
Children who have been subjected to maltreatment will frequently demonstrate a variety of behavioral
and psychologic symptoms, including increased aggressiveness, heightened autonomic arousal, and
memory problems. Neurobiologic explanations suggest that this may be due to:
Selected Answer: D.
Decreased integration of left and right hemispheres
Question 6
1 out of 1 points
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:
Selected Answer: Discuss with Mom nonstimulant options such as atomoxetine
Question 7
1 out of 1 points
Having child and adolescent patients rate their feelings and moods on a scale of 1–10 is most effective
in which age group?
Selected Answer: C.
5 to 11 years
Question 8
1 out of 1 points
John is an 11-year-old male being evaluated for conduct disorder. His history is significant for setting
fires in his neighbor’s garage, repeated episodes of truancy for the last 2 years, and three separate
episodes of running away from home beginning when he was 8 years old. His teacher has reported
that he is quite adept at manipulating his peers to get what he wants, and he has tried to do the same
thing to her. His parents deny any concerns about anger. They are having a hard time believing that
there is a problem because while John has a tendency to pursue dangerous activities, it seems more
like it is just because he is bored. During interview, John does not seem at all hostile or angry. Like
his parents, he does not really seem to think anything is wrong. Which of John’s findings implies the
greatest risk factor for severe, persistent conduct problems?
Selected Answer: C.
His lack of guilt
Question 9
1 out of 1 points
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:
Selected
Answer:
A.
Anticipate that he can tolerate up to a 45-minute session
Question 10
1 out of 1 points
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:
Selected Answer: D.
Social anxiety disorder
Question 11
1 out of 1 points
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:
Selected Answer: D.
Comprehensive psychiatric assessment is indicated
Question 12
1 out of 1 points
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 post-traumatic stress disorder (PTSD)
that is:
Selected
Answer:
B.
Considered by experts to be the first-line management approach for treatment of
PTSD symptoms
Question 13
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: A.
Yes
Question 14
1 out of 1 points
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 2the following are risk factors for predictors of further abuse and maltreatment
except:
Selected
Answer:
D.
Gender of the victim
Question 15
1 out of 1 points
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?
Selected Answer: B.
Masturbating with a toy
Question 16
1 out of 1 points
Minor physical anomalies, such as high-arched palate, low-set ears, and transverse palmar creases,
occur in a higher than average distribution in children with all of the following except:
Selected Answer: D.
Delayed puberty
Question 17
1 out of 1 points
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:
Selected Answer: A.
Separation anxiety disorder
Question 18
1 out of 1 points
Harmony 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:
Selected
Answer:
A.
Brain lesions
Question 19
1 out of 1 points
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:
Selected Answer: C.
The chronology of symptom presentation
Question 20
0 out of 1 points
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:
Selected
Answer:
D.
Suggestive of an abnormality of thought process
Question 21
1 out of 1 points
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:
Selected
Answer:
D.
Communicate to the patient that his or her perspective is valued and will not be
judged or critiqued
Question 22
1 out of 1 points
With respect to treatment of conduct disorder, the PMHNP knows that:
Selected
Answer:
A.
The reduction of violence and aggression in school is critical
Question 23
1 out of 1 points
Which of the following is the most common anxiety disorder of childhood?
Selected Answer: A.
Generalized anxiety disorder
Question 24
1 out of 1 points
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:
Selected
Answer:
B.
This is common, as the symptoms are often only expressed to adults who know
the child well.2
Question 25
1 out of 1 points
The PMHNP is evaluating a 15-year-old male patient who has been referred by his court-appointed
guardian. He has been in foster care for the last 6 years and maintained a steady pattern of low-level
behavior problems such as skipping school and ignoring curfew. He is not openly defiant and has
always been described as a “loner.” He just does not follow most rules. During the mental status
examination, the PMHNP notes that his expressions are sometimes inconsistent with the topic of
conversation, and he does not seem to be able to transition effectively among levels of emotion. This
represents an abnormality in:
Selected
Answer:
B.
Affect
Question 26
1 out of 1 points
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:
Selected Answer: C.
Observation of Eric in a playroom where he is unaware that he is being
watched
Question 27
1 out of 1 points
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:
Selected
Answer:
C.
Motor behavior
Question 28
1 out of 1 points
Which of the following behaviors is least suspicious for an adolescent who is being bullied at school?
Selected
Answer:
A.
A significant change in study habits in which the patient is demonstrating higher
academic achievement to the exclusion of a social life
Question 29
1 out of 1 points
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:
Selected
Answer:
D.
The objective signs evident in Kristina’s examination are more compelling than
her perspective on symptoms
Question 30
1 out of 1 points
Mark is a 5-year-old boy brought in for evaluation because his behavior at school has become so
disruptive. According to the parents, Mark’s teacher says he just refuses to follow the rules of the
classroom, openly defies her, and actually seems to try and upset his classmates. The teacher says
Mark gets frustrated very easily when he cannot complete a task and is resistant to any effort to help
him. This happens almost every day, and the teacher has indicated that she will not be able to keep
him in the classroom if things do not change. Mark’s parents admit that he has always been “willful”
and difficult to manage, but as he is an only child with a stay-at-home mom, the family overlooked his
disruptive tendencies and accommodated Mark. The parents report that they often skip social events
and family outings because they don’t know how Mark will behave. While counseling Mark’s parents
about the theories of causation of oppositional defiant disorder (ODD), the PMHNP tells the parents
that psychiatric theories include all of the following except:
Selected
Answer:
A.
Unresolved conflict as a fuel for aggressive behavior targeting authority figures
Question 31
1 out of 1 points
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:
Selected
Answer:
B.
Karen may be a poor metabolizer of CYP2D6 medications and will need a
change of therapy
Question 32
1 out of 1 points
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:
Selected
Answer:
D.
These same symptoms may occur in the absence of any abuse and are neither
specific or pathognomic for abuse
Question 33
1 out of 1 points
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?2
Selected Answer: B.
Elevated resting heart rate
Question 34
1 out of 1 points
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?
Selected Answer: A.
Child and Adolescent Psychiatric Assessment (CAPA)
Question 35
1 out of 1 points
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:
Selected
Answer:
C.
Assessment without the parents present
Question 36
1 out of 1 points
The PMHNP is drafting a proposal for research funding for a project to offer primary prevention
strategies designed to reduce the incidence of bullying. In support of this project, the PMHNP
provides data supporting the fact that both perpetrators and victims of bullying suffer all of the
following except:
Selected
Answer:
B.
Greater difficulty making friends
Question 37
1 out of 1 points
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:
Selected Answer: D.
Notable decrease in attachment
behaviors
Question 38
0 out of 1 points
Comprehensive psychiatric assessment ultimately requires the integration of biological predisposition,
psychodynamic factors, environmental factors, and life events. These factors, along with a mental
status exam, developmental assessment, and any appropriate standardized testing is collectively
referred to as:
Selected
Answer:
B.
Biopsychosocial formulation
Question 39
1 out of 1 points
The PMHNP is evaluating the data he has collected in the assessment of Anna, a 9-year-old 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:
Selected Answer: B.
May accurately reflect Anna’s behavior in different
settings
Question 40
1 out of 1 points
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:
Selected Answer: D.
Verbal bullying is the most common form
Question 41
1 out of 1 points
While evaluating Jennifer, a 32-month-old female, for autism spectrum disorder (ASD), the PMHNP
conducts a detailed assessment, including a medical history of both the patient and all first-degree
family members. This is critically important as the most common known cause of ASD is:
Selected
Answer:
A.
Fragile X syndrome
Question 42
1 out of 1 points
Because some children exposed to significant traumatic events do not develop post-traumatic stress
disorder (PTSD), there has been research interest in neurobiology and assessment of predisposing or
risk factors. Children with PTSD have been noted to have which of the following when compared to
age-matched controls?
Selected Answer: B.
Lower intelligence quotients
Question 43
0 out of 1 points
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:
Selected
Answer:
D.
Creates a dialogue in which patients cannot give subjective responses
Question 44
1 out of 1 points
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:
Selected Answer: A.
The Children’s Apperception Test (CAT)
Question 45
1 out of 1 points
Which of the following is a true statement with respect to conduct disorder?
Selected
Answer:
C.
About 80% of children with conduct disorder were previously diagnosed with
oppositional defiant disorder (ODD).
Question 46
1 out of 1 points
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:
Selected
Answer:
A.
The child refusing to feed and the mother feeling rejected and withdrawing
Question 47
1 out of 1 points
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:
Selected Answer: B.
Sertraline (Zoloft)
Question 48
1 out of 1 points
Which of the following is not a true statement with respect to theorized etiologies of ADHD?
Selected
Answer:
A.
Psychosocial factors do not appear to contribute to the development of ADHD.2
Question 49
1 out of 1 points
Kelly is a 13-year-old girl who is being evaluated because her parents are very concerned about her
sudden disinterest in school. She does not want to go to any social activities and her grades have
dropped markedly in the last several months. When considering bullying as a cause of her behavior
change, the PMHP considers that which type of bullying is more common among girls?
Selected
Answer:
C.
Relational
Question 50
1 out of 1 points
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:
Selected
Answer:
C.
Generalized anxiety
Question 51
1 out of 1 points
Which of the following manifestations of childhood anxiety disorders is considered a psychiatric
emergency?
Selected Answer: A.
School refusal
Question 52
1 out of 1 points
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:
Selected
Answer:
D.
Problems with the parent-child relationship
Question 53
1 out of 1 points
Carolyn is a 14-year-old female who is in care because she has developed increasingly difficult
behavior at home and school. She is inappropriately dressed for the interview, wearing heavy makeup
and conducting herself in a suggestive manner. Her medical history is significant only for childhood
asthma and four urinary tract infections in the last year. Carolyn’s mother reveals that Carolyn’s
stepfather has a history of sexually abusing his biological daughter, and the mother is beginning to
wonder if something isn’t “going on” in her own home. Carolyn vigorously denies this, and indicates
that her stepfather is very good to her, takes care of her, and is her “best friend.” The PMHNP
recognizes that Carolyn may be in which phase of intrafamilial sexual abuse?
Selected Answer: B.
Secrec
y
Question 54
1 out of 1 points
Michael is a 13-year-old boy who was involved in a traumatic automobile accident in which his
mother, the driver, was killed. After suffering multiple injuries and weeks in the hospital, Michael was
discharged to home with physical therapy. He ultimately made a complete physical recovery but is
unable to get into a car. Just the thought of riding in a car produces profound physiologic symptoms.
He has been diagnosed with post-traumatic stress disorder (PTSD). His avoidance of riding in a car is
conceptualized as:
Selected Answer: B.
Operant conditioning
Question 55
1 out of 1 points
Eric is an 11-year-old male for whom an emergency assessment was requested due to fire-setting.
This is not Eric’s first fire, and his parents admit that he has had a bit of a fixation with the fireplace
and matches for a few years. During the evaluation, the PMHNP should be particularly alert to other
findings consistent with:
Selected
Answer:
D.
Conduct disorder
Question 56
1 out of 1 points
What is the primary diagnostic difference between obsessive-compulsive disorders in children as
compared to adults?
Selected Answer: C.
Recognition that the thoughts or behaviors are irrational
Question 57
1 out of 1 points
Which of the following is a true statement with respect to developmental testing in infants?
Selected
Answer:
C.
Infant assessments are helpful in detecting mental retardation and developmental
disorders.
Question 58
1 out of 1 points
Aa
9-
year
-old
gir
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?
Selected
Answer:
C.
Insistence upon precise placement of plate, cup, utensils and food on plate
when eating; when he cannot achieve this, he will not eat
Question 59
1 out of 1 points
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?
Selected
Answer:
B.
The parents are usually more aware of symptoms than the child.
Question 60
1 out of 1 points
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)?
Selected
Answer:
D.
No controlled studies support that crisis intervention and psychologic debriefing
improves outcomes
Question 61
1 out of 1 points
The PMHNP has been retained by the local school board to provide comprehensive counseling and
guidance following an episode of tragic school violence. A 9
th
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:
Selected Answer: C.
Establishing the perception of safety
Question 62
1 out of 1 points
Which of the following statements is true with respect to children who present to care acutely due to
violent, enraged behavior?
Selected
Answer:
D.
If the child appears to be calming down in the emergency area, the clinician may
ask the child for his version of events.
Question 63
1 out of 1 points
Treatment of abused children is multimodal and long term. The single most important aspect of
treatment is:
Selected
Answer:
A.
Establishing a safe place for the child
Question 64
1 out of 1 points
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?
Selected Answer: D.
The Child and Adolescent Psychiatric Assessment (CAPA)
Question 65
0 out of 1 points
The PMHNP is reviewing assessment data on Richard, a 14-year-old boy who was brought in for
evaluation by his parents. He has a longstanding history of being difficult, defiant, and argumentative
with adults. While considering differential diagnosis of oppositional defiant disorder and conduct
disorder, which of the following findings meet criteria for conduct disorder?
Selected
Answer:
B.
Shoplifts valuable jewelry, is persistently angry and resentful, runs away from
home
Question 66
1 out of 1 points
Management of a child who has a pattern of fire-setting behavior must include:
Selected Answer: B.
Parental counseling that the child should never be allowed home alone
Question 67
1 out of 1 points
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?
Selected Answer: B.
The caretaker is incapable of arranging follow-
up.
Question 68
1 out of 1 points
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:
Selected Answer: D.
Firstborn child in the family
Question 69
1 out of 1 points
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:
Selected Answer: A.
Dissociative disorders
Question 70
1 out of 1 points
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?
Selected Answer: C.
Appreciable ambivalence about suicide
Question 71
1 out of 1 points
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:
Selected Answer: C.
Fluvoxamine (Luvox) 50 mg daily
Question 72
1 out of 1 points
Mrs. Jacobs has accompanied her son to today’s session. Her son is in psychiatric care because he has
developed disciplinary issues and for the last several months has been challenging authority, truant
from school, and openly defiant of the household rules. Mrs. Jacobs is understandably distraught and
is adamant that her son must be the victim of bullying because yesterday he came home from school
with a black eye and a swollen lip. While this has never happened before, she believes that bullying is
the only explanation for his behavior at home. While counseling Mrs. Jacobs about bullying, the
PMHNP emphasizes that, by definition, bullying:
Selected
Answer:
C.
Is always unprovoked and intentionally cruel
Question 73
1 out of 1 points
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:
Selected Answer: A.
Parent training
Question 74
1 out of 1 points
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:
Selected
Answer:
C.
Brief psychotic disorder
Question 75
1 out of 1 points
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:
Selected
Answer:
A.
Structured classroom training with consistent behavioral programs
Question 76
1 out of 1 points
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?
Selected Answer: C.
Coaching Approach behavior and Leading by Modeling
(CALM)
Friday, May 17, 2019 7:25:38 PM EDT
OK
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