NURS 6660N Final Exam-2 Versions 150 Questions & Answers Latest Update 2022/2023, Exams of Nursing

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NURS 6660N Final Exam-2 Versions 150

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2022/

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?

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Chlorprom azi ne The therapeutic outcomes for children with disorders of written expression are most favorable when they are characterized by:

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Intensive, continuous administration of individually tailored, one-on-one expressive and creative writing therapy

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Linda is a 5-year-old girl who has persistent pica; she was finally referred for care when her kindergarten teacher 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 discussing management strategies with Linda’s mother, the PMHNP counsels that the most rapidly successful treatment strategy appears to be:

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Aversi on therap y 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:

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Failure to thrive 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

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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:

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Is a transgender female who identifies as lesbian All the following are true with respect to making a diagnosis of major depressive disorder in children except:

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

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Sterility is a probable consequence of hormone therapy The leading cause of death in youths living in juvenile residential facilities is:

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Suici d e 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:

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Higher socioeconomic status and lifetime psychosis are predictors of more rapid cycling in early-onset bipolar disorder 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:

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Inability to copy correctly from a printed text Which of the following statements best characterized the treatment course and progression of bulimia nervosa?

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Cognitive behavioral therapy is considered the benchmark, first- line treatment.

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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 ideal body weight for 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:

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Hospitalization for controlled weight gain In which demographic is depression twice as prevalent in girls as compared to boys?

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Adolesc en ts 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:

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Focusing the child’s attention to the connections between speech sounds and spelling Which of the following symptom clusters is most likely in a 16-year-old male with major depressive disorder?

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Pervasive anhedonia, hopelessness, and severe psychomotor retardation 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?

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Prepubertal children having a depressive episode secrete significantly more growth hormone during sleep than nondepressed children.

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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?

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Deteriorating function over the last several months Learning disorders affect at least 5% of all school-aged children in the United States. Since 1975, Public Law 94-142 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:

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Reading disorders 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:

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B.

P

overty of speech content The PMHNP is working with rural primary care providers to increase awareness of mental health disorders in infancy and early childhood. The program includes a session on screening for feeding disorders in infants. If an infant is either observed by the provider or reported by the parent to frequently suck the tongue rhythmically or appear to strain with his or her back arched and then swallow, the examiner should consider the possibility of:

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Inadequate emotional attachment

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Which of the following is a true statement with respect to avoidant/restrictive food intake disorder?

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Approximately 70% of infants who persistently refuse food continue to have some eating problems during childhood. Regarding pediatric suicide, which of the following is a true statement?

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Worldwide, suicide very rarely occurs in children who have not reached puberty. 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 in foster care vs. one who lives in an orphanage. While counseling this couple, the PMHNP advises them that:

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Younger children adopted from foster care settings have the best outcomes

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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:

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More recent research suggests that this is not accurate and that treatment actually decreases risk of suicide

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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?

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Answer: Alleviating

negative symptoms While counseling the parents of Joshua, a 9-year-old patient with developmental coordination disorder, the PMHNP advised that the treatment will include:

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Modified physical education 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?

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D. Stress-

diathesis Standardized instructional programs used in the management of reading disorders include all the following except:

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

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Attention deficit hyperactivity disorder

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

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Answer: Flexible

sex rearing 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 her meals. 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:

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An irritable, apathetic, or anxious affect Rose is a 13-year-old girl who is being evaluated as part of a family assessment; the primary patient is Rose’s 8-year-old brother who is demonstrating behavior of concern and is having a court-ordered evaluation. During the family assessment, it becomes apparent that Rose’s mother is very concerned that Rose is a tomboy. The mother, who is very elegant, is distressed by Rose’s persistent

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“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?

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Rose does not appear to have concerns about her gender identity of sexuality and no further evaluation is indicated.

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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 in foster care as 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:

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The history and reported symptoms are typical of depressive disorder in young children 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:

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C.

T

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

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The PMHNP should not be concerned with consent for disclosure when child abuse or maltreatment has occurred. Which of the following is a true statement with respect to developmental coordination disorder?

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

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T h e P M H N P i s p r e p a r i n g a p r e s e n t a t i o n f or a conference of pediatric primary care providers. The topic of the presentation is early identification and referral of developmental coordination disorder. When outlining high-risk populations, the PMHNP discusses that statistically there is a higher incidence of occurrence in children with all of the following except:

Selected Answer:

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D. Oppositional^ defiant

disorder (ODD)

A 14-year-old boy was presented to care by his parents because of progressive social

withdrawal. Upon completion of 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?

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Symptoms not resolved for more than 2 months at a time 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

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therapy. While counseling Debi’s parents about important issues in management, the PMHNP advises that:

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20 to 40% of adolescents who have major depressive disorder will develop bipolar I within 5 years The current scholarly consensus is that the etiology of bulimia nervosa is multifactorial to include biological, sociocultural, family, cognitive- behavioral, and psychodynamic factors.

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When considering the etiology of bulimia nervosa, the PMHNP understands that:

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Lowered serotonin activity is seen in the brains of patients with bulimia nervosa. 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:

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Laboratory assessment of hemogram, iron, zinc, and lead levels 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?

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Physical restlessness and poor judgment

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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?

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The diagnosis is controversial because few children this age exhibit discrete mood cycles. Marion is a 17-year-old female who has been referred by her high school guidance counselor for 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 C.

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Answer: Some^ form^ of

disorder of menstruation 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?

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Developmental coordination disorder 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?

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Delayed motor milestones and language acquisition When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

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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:

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Pharmacotherap y for bipolar I

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Christine is a 9-year-old female who presents for care after having been placed in the local foster care system. 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:

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Attachm ent disorder 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:

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Taper the fluoxetine off and see if these symptoms improve 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?

Select ed Answer:

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