Walden NURS6660 Midterm

Question 1
Which of the following statements is true with respect to
children who present to care acutely due to violent, enraged behavior?
A.
Under no circumstances should the PMHNP approach this
patient.
B.
Prepubertal children typically require medication as they
are too young to respond to conversation.
C.
Children who have a history of repeated, self-limited,
severe tantrums require at least a 72-hour admission.
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 2
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
Question 3
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
Question 4
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
Question 5
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
Question 6
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:
A.
Review of a video recording of a nightmare event and Eric’s
immediate response
B.
Age-appropriate interview, e.g., ?If you had three wishes,
what would they be??
C.
Observation of Eric in a playroom where he is unaware that
he is being watched
D.
Partially open-ended questions that provide some focus but
allow expression of feeling
Question 7
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
Question 8
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:
A.
Talk with the examiner via dolls
B.
Respond to open-ended questions
C.
Draw family members and peers
D.
Complete an MMPI
Question 9
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:
A.
Does not offer flexibility in understanding the evolution of
the problem
B.
Frequently deemphasizes the influence of environmental
factors
C.
May not systematically cover all psychiatric diagnostic
categories
D.
Creates a dialogue in which patients cannot give subjective
responses
Question 10
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:
A.
Neuropsychiatric assessment
B.
Biopsychosocial formulation
C.
The Physical and Neurological Examination of Soft Signs
(PANESS)
D.
Kaufman Assessment Battery for Children
Question 11
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
Question 12
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?
A.
The parents’ own emotional adjustments should be determined.
B.
The parents are usually more aware of symptoms than the
child.
C.
The parents may prefer to speak with the PMHNP separately.
D.
The parents’ upbringings are relevant to the child’s
diagnosis.
Question 13
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:
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
Question 14
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?
A.
Selective serotonin reuptake inhibitors (SSRI)
B.
SSRI in combination with CBT
C.
Coaching Approach behavior and Leading by Modeling (CALM)
D.
CALM in combination with a first-generation antihistamine
Question 15
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:
A.
The presence of imaginary play
B.
A failed hearing test
C.
Exaggerated response to minor injury
D.
Notable decrease in attachment behaviors
Question 16
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
Question 17
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
Question 18
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:
A.
Most effective when paired with eye movement desensitization
and reprocessing (EMDR)
B.
Considered by experts to be the first-line management
approach for treatment of PTSD symptoms
C.
Very effective in individuals but generally not recommended
for group treatment, e.g., school-based traumas
D.
Gaining widespread acceptance as a first-line management
strategy for other forms of anxiety disorders
Question 19
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
Question 20
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
Question 21
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:
A.
Parent training
B.
Pharmacotherapy
C.
Time out
D.
Conflict avoidance
Question 22
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:
A.
Brain lesions
B.
Early-onset schizophrenia
C.
Low intelligence
D.
Learning disability
Question 23
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
Question 24
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?
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.
Question 25
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
Question 26
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:
A.
Single-parent families
B.
Low parental education
C.
Parental substance abuse
D.
Firstborn child in the family
Question 27
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
Question 28
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:
A.
Psychiatric hospitalization
B.
Cognitive behavioral therapy
C.
Fluvoxamine (Luvox) 50 mg daily
D.
Family interventions
Question 29
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)
Question 30
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:
A.
Separation anxiety disorder
B.
Social anxiety disorder
C.
Generalized anxiety disorder
D.
Social phobia disorder
Question 31
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:
Discuss with Mom nonstimulant options such as atomoxetine
Reduce his dose back to 5 mg b.i.d. until adverse effects
resolve
Add 25 mg of diphenhydramine to his daily regimen at h.s.
Continue the current plan of care and reassess in 1 month
Question 32
Management of a child who has a pattern of fire-setting
behavior must include:
A.
Combination therapies that include medication with an SSRI
B.
Parental counseling that the child should never be allowed
home alone
C.
Inpatient admission for intensive individual and group
therapy
D.
Behavioral interventions characterized by negative
reinforcement
Question 33
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
Question 34
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:
A.
Likely indicates a subjective bias from the mother or
teacher
B.
May accurately reflect Anna’s behavior in different settings
C.
Requires that other adults exposed to Anna’s behavior
provide input
D.
Indicates that a different approach to Anna’s assessment is
necessary
Question 35
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:
A.
The absence of a remote history of psychiatric disease makes
a true psychiatric diagnosis unlikely
B.
The PMHNP must prioritize Kristina’s subjective report
versus her parents’ report
C.
A standardized assessment tool such as the Patient Health
Questionnaire (PHQ)-9 will be required for diagnosis
D.
The objective signs evident in Kristina’s examination are
more compelling than her perspective on symptoms
Question 36
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?
A.
Overactive amygdalae
B.
Lower intelligence quotients
C.
Preexisting personality disorders
D.
Fourfold risk when first-degree family member affected
Question 37
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.
Complete absence of any other psychiatric diagnoses
Question 38
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:
A.
He will need to have more information from adults who are
not in frequent contact with Lorraine
B.
This is common, as the symptoms are often only expressed to
adults who know the child well.
C.
ODD is episodic, and it is not unusual to have long
symptom-free periods; a normal interview does not preclude diagnosis
D.
The diagnosis should be reconsidered as it is almost
impossible to have a diagnosis of ODD without the patient’s awareness of
symptoms
Question 39
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)
Question 40
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
Question 41
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:
A.
At some point will always involve physical aggression
B.
Does not occur unless more than one aggressor participates
C.
Is always unprovoked and intentionally cruel
D.
Rarely results in permanent, irreversible physical harm
Question 42
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.
Relational
D.
Cyber
Question 43
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.
Question 44
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:
A.
Mood
B.
Affect
C.
Thought process and content
D.
Judgment and insight
Question 45
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
Question 46
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.
Engagement
B.
Secrecy
C.
Disclosure
D.
Suppression
Question 47
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?
A.
The fire setting
B.
Running away beginning at age 8
C.
His lack of guilt
D.
Truancy prior to age 10
Question 48
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
Question 49
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?
A.
Clear social difficulties in addition to an apparently
unusual need for cleanliness and order in his bedroom
B.
Refusal to go to bed without his blue stuffed elephant; this
began over a year ago and is getting progressively worse
C.
Insistence upon precise placement of plate, cup, utensils
and food on plate when eating; when he cannot achieve this, he will not eat
D.
A concomitant diagnosis of ADHD for which the family is
currently in behavioral therapy
Question 50
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?
A.
Delayed developmental milestones
B.
Elevated resting heart rate
C.
Pupillary constriction during cognitive tasks
D.
Youngest child in birth order
Question 51
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
Question 52
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
Question 53
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:
A.
Childhood schizophrenia
B.
Bipolar disorder
C.
Sexual abuse
D.
Conduct disorder
Question 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
Question 55
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
Question 56
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
Question 57
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
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.
Question 59
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:
A.
Fragile X syndrome
B.
Advanced maternal age
C.
Autoimmune disease in > 2 first-degree family members
D.
Being raised in a single-parent home during the first year
of life
Question 60
Evaluation of psychiatric emergencies in children must
include:
A.
A complete physical examination
B.
Psychiatric disorders in family members
C.
A comprehensive toxicology screen
D.
Interviews with teachers and noncustodial caretakers
Question 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 a standardized-testing assessment
C.
Schedule session two after reviewing court documentation
D.
Arrange for three sessions with a family therapist then
reevaluate Kevin
Question 62
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:
A.
Scarring of the hippocampus
B.
Hypertrophy of the corpus callosum
C.
Limbic suppression
D.
Decreased integration of left and right hemispheres
Question 63
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
Question 64
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.
Question 65
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
Question 66
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
Question 67
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
Question 68
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)?
A.
Crisis intervention and psychologic debriefing is most
effective if it occurs within 24 hours of the event
B.
The focus of crisis intervention and psychologic debriefing
is management of emotional reactions
C.
Psychoeducation is not typically a component of crisis
intervention and psychologic debriefing
D.
No controlled studies support that crisis intervention and
psychologic debriefing improves outcomes
Question 69
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
Question 70
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:
A.
Symptoms of childhood schizophrenia
B.
A manic episode
C.
Brief psychotic disorder
D.
Intermittent explosive disorder
Question 71
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
Question 72
Which of the following is not a true statement with respect
to theorized etiologies of ADHD?
A.
Psychosocial factors do not appear to contribute to the
development of ADHD.
B.
Some literature suggests that prenatal exposure to winter
infection during the first trimester of pregnancy leads to ADHD
C.
Biological parents of children with ADHD have a higher
incidence of the disorder than adoptive parents
D.
Overall, no clear-cut evidence supports a single
neurotransmitter in the development of ADHD
Question 73
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:
A.
Dissociative disorders
B.
Negative attachment
C.
Aggression toward siblings
D.
School refusal
Question 74
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:
A.
Structured classroom training with consistent behavioral
programs
B.
Facilitated communication with a computer or letter/picture
board
C.
A trial of escitalopram daily to promote decreased
irritability
D.
An atypical antipsychotic as needed to decrease
self-injurious behavior
Question 75
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