1
The PMHNP is evaluating a 15-year-old male patient who has been referred by his
courtappointed guardian. He has been in foster care for the last 6 years and maintained
a steady pattern of low-level behavior problems
...
1
The PMHNP is evaluating a 15-year-old male patient who has been referred by his
courtappointed guardian. He has been in foster care for the last 6 years and maintained
a steady pattern of low-level behavior problems such as skipping school and ignoring
curfew. He is not openly defiant and has always been described as a ―loner.‖ He just
does not follow most rules. During the mental status examination, the PMHNP notes that
his expressions are sometimes inconsistent with the topic of conversation, and he does
not seem to be able to transition effectively among levels of emotion. This represents
an abnormality in:
A. Mood
B. Affect
C. Thought process and content
D. Judgment and insight
Question: 2
A variety of diagnostic instruments are available to assist the PMHNP with
comprehensive data collection. Which of the following tools is considered an
―interviewer-based‖ tool designed as a guide to clinicians designed to help clarify
answers to questions?
A. The Children's Interview for Psychiatric Symptoms (ChIPS)
B. The Diagnostic Interview for Children and Adolescents (DICA)
C. The Pictorial Instrument for Children and Adolescents (PICA-III-R)
D. The Child and Adolescent Psychiatric Assessment (CAPA)
3 61 Kevin is a 15-year-old male who presents for court-ordered psychiatric assessment.
Kevin comes to his first appointment with both of his parents. He is sitting in the chair
with his arms crossed and responds with ―yes‖ and ―no‖ answers to direct questions;
otherwise, he volunteers no information. The parents are clearly upset and indicate they
just ―don't know what to do with him anymore.‖ The most appropriate action for the
PMHNP would be to:
A. Ask the parents to step out and interview Kevin privately
B. Have Kevin complete the standardized-testing assessment
C. Schedule session two after reviewing court documentation
D. Arrange for three sessions with a family therapist then reevaluate Kevin
4 the PMHNP observes separation from and reunion with the parent as part the mental
status exam of a 25-month-old toddler. Extremes of emotion during separation or
reunion are most consistent with:
A. Normal developmental progression at that age
B. Cognitive dysfunction
C. Neurologic dysfunction
D. Problems with the parent-child relationship
5 the PMHNP is performing an emergency assessment on Renee, a 9-year-old girl who
was initially brought to the attention of social services by her maternal grandmother.
Renee is reluctant to talk about herself or her home life. The physical examination that
accompanied this emergency assessment revealed a variety of ecchymoses in various
stages of healing, and the examiner was suspicious that there was a history of sexual
abuse. Renee is quiet and passive during the interview, but is rather aggressive when
playing with dolls. While considering the need for removal from the home, the PMHNP
knows that all the following are risk factors for predictors of further abuse and
maltreatment except:
A. Neglect as the form of maltreatment
B. Parental conflict
C. Number of previous episodes
D. Gender of the victim
Question 22
6Harmony is a 4-year-old female who has been through several evaluations for
behavioral
abnormalities that have become increasingly disruptive, and the family is concerned for
the safety of both Harmony and her 2-year-old brother. Comprehensive assessment of
Harmony includes neuropsychiatric testing. The PMHNP documents the presence of
neurological hard signs. These suggest:
A. Brain lesions
B. Early-onset schizophrenia
C. Low intelligence
D. Learning disability
Question 20
7During the mental status exam of Oliver, a 4-year-old child, the PMHNP appreciates
that he
appears to be having transient visual and auditory hallucinations. The PMHNP knows
that the best approach to this finding is to consider that:
A. This is most consistent with early-onset schizophrenia
B. An organic brain disorder should be ruled out
C. These are normal findings in very young children
D. Comprehensive psychiatric assessment is indicated
8Question 54
The PMHNP has been retained by the local school board to provide comprehensive
counseling
and guidance following an episode of tragic school violence. A 9th grader, acting alone,
brought a gun into the school, fatally shooting a teacher and injuring four other teachers
and students before he was subdued. In an effort to promote best healthy practices
after this traumatic event, the school board is asking for advice on how to best manage
the students. The PMHNP knows that the immediate priority must be:
A. Returning to normal routine immediately
B. Development of peer counseling groups
C. Establishing the perception of safety
D. A memorial service to process the loss
969
Jenny is a 5-year-old female who has been referred for consultation because the
emergency room
physician suspects that she might be subject to physical abuse in the home. On
evaluation, the PMHNP finds Jenny to be fearful, docile, and guarded. Although clearly in
pain, Jenny seems surprised when the PMHNP attempts to provide some comfort. The
PMHNP notes that:
A. If Jenny demonstrates abnormal attachment with her mother, this will complete
textbook criteria for symptoms of physical abuse
B. There must be a consistent pattern of atypical physical injury to support the
diagnosis of physical abuse
C. Jenny's behaviors are more consistent with sexual abuse than physical abuse
D. These same symptoms may occur in the absence of any abuse and are
neither specific or pathognomic for abuse
10
Kelly is an 8-year-old girl who is being evaluated by the PMHNP because she is markedly
behind her
peers in school performance. During her mental status examination, she is unable to
repeat three objects after five minutes, and is unable to repeat five digits forward or
three digits backward. Further evaluation reveals an inability to add single digits. The
PMHNP interprets this finding as:
A. Consistent with her developmental milestone expectations
B. A manifestation of profound anxiety
C. Reflective of brain damage or learning disabilities
D. Suggestive of an abnormality of thought process
11
Richard is an 11-year-old patient who has been hospitalized following a suicide attempt
in which he mixed a variety of household cleansers and poisons and swallowed them.
He has been medically cleared, and his initial psychiatric assessment reveals a
preadolescent male who made this suicide attempt because he was so unhappy at
school. His family recently moved from another part of the country and he started a new
school. The other children have been bullying him, and he just decided it would be
better to die. He has no siblings and no friends in this new town. Which additional
findings during this assessment would prompt the PMHNP to suggest a psychiatric
admission?
A. His mother has a history of severe post-partum depression
B. A finding of mild depression during this examination
C. Appreciable ambivalence about suicide
D. absence of any other psychiatric dia
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