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 a
...
Jack is a 3-year-old boy who is being evaluated for developmental delay. The mental status
examination is significant for an inability to stack two blocks or draw a circle. The PMHNP
also appreciates the inability to attend to any task for more than a few seconds. These
findings indicate an abnormality in:
A
.
Social relatedness
B
.
Thought process and
content
C
.
Motor behavior
D
.
Judgment and insight
C
During the mental status exam of Oliver, a 4-year-old child, the PMHNP appreciates that he
appears to be having transient visual and auditory hallucinations. The PMHNP knows that the
best approach to this finding is to consider that:
A
.
This is most consistent with early-onset
schizophrenia
B
.
An organic brain disorder should be ruled out
C
.
These are normal findings in very young
children
D
.
Comprehensive psychiatric assessment is
indicated
B
Jason is a 17-month-old male who is referred for evaluation of an unusually high level of
irritability. His mother says he cries “all the time,” and sometimes he just cannot be
comforted; Jason’s pediatrician felt that the complaint warranted an evaluation by child
psychiatry. Comprehensive assessment of Jason’s irritability should include all the following
except:
A
.
A comprehensive medical
assessment
B
.
Standardized developmental
measures
C
.
Assessment without the parents
present
D
.
Observation of Jason during play
NURS 6660 Midterm Exam Questions and Answers
D
Which of the following is the most common anxiety disorder of childhood?
A
.
Generalized anxiety
disorder
B
.
Separation anxiety
disorder
C
.
Social anxiety disorder
D
.
Obsessive-compulsive
disorder
A
When evaluating treatment strategies for a 14-year-old patient with obsessive-compulsive
disorder (OCD), the PMHNP considers that evidence-based data from the Pediatric OCD
Treatment Study (POTS) suggests that best outcomes are achieved with cognitive behavioral
therapy (CBT) and:
A
.
Clomipramine
(Anafranil)
B
.
Sertraline (Zoloft)
C
.
Aripiprazole (Abilify)
D
.
Lithium (Eskalith)
B
Which of the following behaviors is least suspicious for an adolescent who is being bullied at
school?
A
.
A significant change in study habits in which the patient is demonstrating higher
academic achievement to the exclusion of a social life
B
.
A persistent, sustained increase in the number and variety of physical complaints that
have no obvious organic cause
C
.
Evidence that the patient has started smoking cigarettes and seems to spend more time
alone than usual
D
.
Migration to a completely different peer group and a change in appearance and behavior
to aggressively mimic the new group
A
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:
A
.
Panic attacks
B
.
Operant
conditioning
C
.
Hyper arousal
D
.
Flashbacks
C
Which of the following is a true statement with respect to developmental testing in infants?
A
.
None of the available validated developmental tools are reliable in infants under 6
months of age.
B
.
An infant’s score on developmental assessment is a reliable predictor of future
intelligence quotient.
C
.
Infant assessments are helpful in detecting mental retardation and developmental
disorders.
D
.
Assessment in older infants focuses on sensorimotor and social responses.
C
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 firstfloor apartment. She was unhurt, but when the neighbor asked why she jumped out she said
she wanted to kill herself. Which coincident finding would warrant an inpatient psychiatric
admission for Wendy?
A
.
This was not the first episode.
B
.
The caretaker is incapable of arranging follow-up.
C
.
One or both of the biological parents has a history of
suicide attempts.
D
.
Wendy was left with a babysitter when the incident
occurred.
B
Caleb is a 10-year-old boy who is referred for assessment because he is not following any of
the rules of discipline at home. His parents report that they have had three separate nannies
resign in the last 4 months because Caleb is unmanageable. This is a long-standing problem,
going back to daycare even before kindergarten. The PMHNP knows that when conducting
her initial interview of Caleb she should:
A
.
Anticipate that he can tolerate up to a 45-
minute session
B
.
Consider that symbolic play with dolls will be
informative
C
.
Interview him alone before involving the parents
D
.
Be clear that he is there because of problem
behavior
D
Treatment of abused children is multimodal and long term. The single most important aspect
of treatment is:
A
.
Establishing a safe place for the
child
B
.
Exposure related to the feared
experience
C
.
Psychoeducation
D
.
Cognitive-behavioral interventions
A
Psychiatric assessment of the adolescent patient is different in several ways from
assessment of younger children. While trying to establish a therapeutic environment with an
adolescent who is openly hostile, one of the most important things the PMHNP can do is to:
A
.
Be more liberal in terms of limit setting and tolerating hostility in order to facilitate honest
communication
B
.
Ensure the patient that under no circumstances will anything said be repeated to the
parents
C
.
Allow silences to last as long as necessary until the patient is inclined to offer any verbal
input
D
.
Communicate to the patient that his or her perspective is valued and will not be judged
or critiqued
A
A variety of questionnaires, scales, guided-interview tools, and other standardized
instruments are available to aid with various aspects of assessment. The majority are
intended only to be used as an aid to information gathering and not to make a diagnosis.
Which of the following tools requires training to administer and can be used to determine
diagnoses?
A
.
Child and Adolescent Psychiatric Assessment (CAPA)
B
.
Brief Impairment Scale
C
.
Pictorial Instrument for Children and Adolescents
(PICA-III-R)
D
.
Achenbach Child Behavior Checklist
C
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:
A
.
Higher incidence of emotional
problems
B
.
Greater difficulty making friends
C
.
Poorer academic achievement
D
.
Increased percentage of smoking
D
Which of the following manifestations of childhood anxiety disorders is considered a
psychiatric emergency?
A
.
School
refusal
B
.
Bedtime
refusal
C
.
Eating
refusal
D
.
Speech
refusal
A
The PMHNP is performing an assessment on Julie, a 4-year-old girl who has been brought to
care by her mother. The mother was referred by the pediatrician because Julie has been
demonstrating an appreciable change in her behavior. She is developmentally on target and
has always been a happy and curious child, but for the last few months she seems to be
much more fearful and anxious. Which of the following recently acquired behaviors
described by the mother is most suspicious for sexual abuse?
A
.
Prolonged periods of daydreaming
B
.
Masturbating with a toy
C
.
Touching the genitals of her 3-year-old
cousin
D
.
Showing her genitals to other children at
daycare
B
What is the primary diagnostic difference between obsessive-compulsive disorders in
children as compared to adults?
A
.
Age of onset
B
.
Response to treatment
C
.
Recognition that the thoughts or behaviors are
irrational
D
.
The thoughts or behaviors occupy > 1 hour
daily
A
With respect to treatment of conduct disorder, the PMHNP knows that:
A
.
The reduction of violence and aggression in school is critical
B
.
Parental psychiatric intervention has not demonstrated
improved outcomes
C
.
Atypical antipsychotics are avoided due to the adverse effect
profile
D
.
Treatment with psychostimulants exacerbates aggressive
behaviors
A
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?
A
.
Verbal
B
.
Physical
C
.
Relation
al
D
.
Cyber
A
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-thecounter, or herbal medications. The PMHNP considers that:
A
.
These are common in the first weeks of therapy and the dose should be increased to a
therapeutic regimen
B
.
Karen may be a poor metabolizer of CYP2D6 medications and will need a change of
therapy
C
.
Behavioral modalities should be started as optimal management of ADHD is multimodal
D
.
Fluoxetine should be added to the regimen as it has demonstrated efficacy with
coincident anxiety
A
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?
A
.
Engagem
ent
B
.
Secrecy
C
.
Disclosure
D
.
Suppressi
on
B
Phillip is a 5-year-old boy who is in care after being referred for failure to speak at school. He
has been in kindergarten for 5 months, and initially his teacher thought he was just shy, so
she did not focus on him. However, it has become increasingly apparent that he flat out will
not speak at school. Phillip’s parents are adamant that there is not any problem at home and
that Phillip talks with them and his older sister routinely. Further assessment reveals that he
has always been extremely shy and that he doesn’t like it when people make a fuss over
him. The PMHNP suspects that Phillip has selective mutism, which is closely related to:
A
.
A history of sexual
abuse
B
.
Fetal alcohol
syndrome
C
.
Early onset
schizophrenia
D
.
Social anxiety
disorder
D
With respect to psychiatric assessment, the PMNHP knows that in terms of confidentiality:
A
.
All information related to a minor may be shared with the parents without the
child’s consent.
B
.
Whenever there is a suspicion of neglect or abuse, the appropriate state agency
must be notified.
C
.
Every state has laws that emancipate children for issues of mental health.
D
.
All children are entitled to confidentiality unless they are a danger to themselves
or others.
B
The PMHNP is performing a series of court-ordered home visits to evaluate concerns about a
4-month-old infant who presented for a well checkup with clear failure to thrive. While
observing the mother’s interaction with the infant, the PMHNP notes a negative pattern of
interaction. This is characterized by:
A
.
The child refusing to feed and the mother feeling rejected and withdrawing
B
.
The mother not holding the child during feeding and the child withdrawing
C
.
The mother not responding to hunger cues, e.g., crying, and the child stopping
demonstrating them
D
.
The mother being overly protective and trying to feed excessively, and the infant
stopping eating
B
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
D
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?
A
.
Openly defies rules, argues with adults, is truant from school
B
.
Shoplifts valuable jewelry, is persistently angry and resentful, runs away from home
C
.
Often loses temper in the classroom, upturned a desk at school in anger, is verbally cruel
to classmates
D
.
Has a history of physical cruelty to the family cat, broke into the neighbors’ house while
they were on vacation, starting fist fights at school
D
Melanie is a 13-month-old female who has been referred by her primary care pediatrician.
She has not had consistent well-child checks, and at her first visit with this pediatrician at
age 1 year, there was a notable absence of verbal babbling, interactive play, or smiling.
Comprehensive assessment of Melanie must include all the following except:
A
.
The Children’s Apperception Test
(CAT)
B
.
A comprehensive history
C
.
A mental status examination
D
.
Neuropsychiatric assessment
C
Despite a wealth of data-based information on bullying, including information about its
forms, presenting symptoms, and consequences, current research suggests that accurate
information about bullying is not influencing preventive and awareness strategies in most
school systems. When advising school personnel, parents, and primary care providers about
bullying, the PMHNP should emphasize that:
A
.
Physical bullying has the most dangerous
outcomes
B
.
Bullying is more common in boys than girls
C
.
Victims often develop alcohol abuse
problems
D
.
Verbal bullying is the most common form
D
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:
A
.
Learning disabilities
B
.
Speech and language
disorders
C
.
Hyperactivity
D
.
Delayed puberty
D
Comprehensive psychiatric assessment of young school-aged children requires a variety of
information sources. Input is necessary from parents, caregivers, and teachers because
children of this age group cannot reliably provide information about:
A
.
Their own fears and anxieties
B
.
Psychotic episodes they have
experienced
C
.
The chronology of symptom
presentation
D
.
Episodes of mood extremes
C
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:
A
.
Unresolved conflict as a fuel for aggressive behavior targeting authority figures
B
.
The concept that oppositionality is a reinforced, learned behavior in which the child exerts
control over authority figures
C
.
A maladaptive response to parents’ modeling of conflict avoidance as manifested by
even-tempered responses to parent-toddler struggles
D
.
That the behavior is reinforced by increased parental attention in response to the
undesirable behavior
C
Having child and adolescent patients rate their feelings and moods on a scale of 1–10 is
most effective in which age group?
A
.
18-months to 3
years
B
.
3 to 5 years
C 5 to 11 years
.
D
.
12 to 17 years
C
Which of the following is a true statement with respect to conduct disorder?
A
.
The diagnosis is distributed equally between boys and girls.
B
.
Boys with conduct disorder are more likely to develop somatic symptoms later in life.
C
.
About 80% of children with conduct disorder were previously diagnosed with oppositional
defiant disorder (ODD).
D
.
The later the age of onset of conduct disorder, the greater the risk of antisocial
personality disorder (ASPD) in adulthood.
C
Being Brave: A Program for Coping With Anxiety for Young Children and Their Parents is a
manualized intervention for anxiety disorders in young children between the ages of 4 and 7
years old. It uses a combination of parent-only and parent-child sessions and demonstrates
significant improvement in children with all forms of anxiety disorders except:
A
.
Separation
anxiety
B
.
Social anxiety
C
.
Generalized
anxiety
D
.
Specific phobia
C
Eric is an 11-year-old male for whom an emergency assessment was requested due to firesetting. 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:
A
.
Childhood
schizophrenia
B
.
Bipolar disorder
C
.
Sexual abuse
D Conduct disorder
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