NR-606 Final Exam Questions and Answers

NR-606 Final Exam Questions and Answers What is the DSM-5 definition of ADHD? A persistent pattern of selective attention and/or hyperactivity and or impulsivity that interferes with functioning or development. The patient should usually have 6 or more symptoms of selective attention, hyperactivity and impulsivity for 6 months or longer. Symptoms interfere with social, academic, or occupational functioning symptoms are present in two or more setting What are some s/s of selective attention (refers to the ability to focus on specific information or stimuli while actively filtering out irrelevant distractions, essentially choosing what to pay attention to) within children with ADHD? lack of attention to detail, carelesnessness, not listening, losing things, diverting attention, forgetfulness. What are some s/s of impulsivity? Not waiting your turn, blurting things out, interrupting, excessive talking What are some s/s of hyperactivity? trouble playing quietly, leaving ones set, running/climbing, fidgeting What are some s/s of lack of sustained attention? poor problem solving, difficulty completing tasks, disorganization, difficulty sustaining mental effort When is ADHD usually diagnosed and what gender does it mainly affect? It is diagnosed within early childhood to adolescents. ADHD has a 2:1 male to female ratio. What is the importance of early ADHD diagnosis and treatment? ADHD symptoms may be mild or so severe and persistent that they interfere with virtually all aspects of a person's life. Without early identification and proper treatment, ADHD can cause disruptions in academic performance, family stress, difficulties in social relationships, and accidental injuries. What are the lasting consequences of non-treatment of ADHD in children? Children with ADHD may experience delays in speech, motor, and social development. They often demonstrate reduced behavioral inhibition, emotional dys-regulation or impulsivity, and negative emotionality. Some children with ADHD have challenges with working memory. ADHD typically presents with_________ IN EARLY CHILDHOOD. HYPERACTIVITY What is the difficult about diagnosing ADHD in children under the age of 4? It can be hard to distinguish actually ADHD symptoms from normal neurotypical children. _______ FEATURES become more prominent in PRESCHOOL and ELEMENTARY school, which is when ADHD is most often diagnosed. Inattentive. Young children can experience developmental delays and may engage in behaviors that are less mature than their peers. In adolescence, signs of hyperactivity become less common, but some adolescents experience a worsening of the condition with development of _______ behaviors. Anti-social Teens with ADHD are at risk for poor academic performance, problems with driving, difficulties with social situations, risky sexual behavior, and substance abuse.- Particularly untreated As clients reach adolescence, hyperactive symptoms may decline and become less apparent to others, but adolescents and adults with ADHD may still struggle with executive function, attention, and working memory, which can create problems with day-to-day functioning, performance at work, and relationships. How would you as a PMHNP screen or diagnose ADHD? To make an informed diagnosis, it is essential to gather data from multiple sources, including the client, parents, and teachers of children and adolescents. Several instruments are available, either free or for a fee, to assist in diagnosis, as well as to monitor changes in symptoms during treatment. You can use the Vanderbilt scale- FREE Connor Scale- not free What are some co-morbidities of ADHD? Substance use disorder, depression, anxiety, OCD, Bipolar Common co-occurring conditions include learning disabilities, conduct disorders, tics, anxiety, depression, and language disorders; adolescents are at increased risk of substance use disorders. Consideration must be given to whether the presenting symptoms are attributed to ADHD, another disorder, or to both disorders to make an accurate diagnosis and treatment plan. How is treatment typically handled when a child has ADHD AND a co-existing mental health ailment? Children with co-occurring conditions are often treated first for ADHD and then for comorbidities, as treating ADHD symptoms first may help reduce overall stress levels and provide a clearer picture of the comorbid symptoms What is the first-line treatment for ADHD? A stimulant medication. A non-stimulant is used if a stimulant is contraindicated or if a stimulant is not effective. However remember that treatment of ADHD is multi-modal, often requiring medical, educational, behavioral, and psychological intervention. ________ can help lower distractibility and improve attention, working memory, and impulsivity. Non-stimulants How would you treat a patient who is having argumentative or oppositional symptoms? A combination of stimulants and non-stimulants can be used What cardiac considerations should be considered before starting any patients on a stimulant? A cardiac workup should be completed. An electrocardiogram (EKG) is required if cardiac history is present in a first-degree relative. (it can help identify potential underlying heart conditions that could be adversely affected by the medication, even if the patient appears healthy, as stimulants can slightly increase heart rate and blood pressure, potentially causing complications in individuals with undiagnosed heart issues; this practice is recommended by the American Heart Association (AHA) to prioritize patient safety. ) and ensure to document this. What bio-metric considerations should be considered before starting any patients on a stimulant? Monitor BP, height and weight during every appointment. (ensure the child is not experiencing abnormal BP, ensure stimulant is not affecting the child's growth and development. Ensure the medication is not cause anorexia within the patient. Stimulants decrease appetite. What mental health considerations should be considered before starting any patients on a stimulant? - Assess all clients for bipolar disorder before treatment. Central nervous system (CNS) stimulants may cause psychotic or manic symptoms in clients with no prior history or may exacerbate behavior disturbance symptoms and thought disorders in clients with pre-existing psychosis. - CNS stimulants may exacerbate comorbid anxiety and substance use disorders. What are two teaching points for patients if they begin to complain of insomnia while on a stimulant? Take the medication AT NIGHT or do not take the medication past a certain time. Increased irritability and insomnia can be treated with a low dose of nonstimulant medication which will allow the client to fall asleep. If a patient has current tics, what is a great teaching recommendation? Stimulants can cause or worsen tics; stimulants may unmask the presence of tics. How soon would a patient/parents see the efficacy of a stimulant or non-stimulant? within the first week! These medications begin to work 30-60 minutes after ingestion and last for a duration of up to 4-12 hours. If a patient needed to be switched from one stimulant medication to the next, how would you do it? Discontinue one medication and start the next medication at the starting dose the next day. NOT THE SAME DAY How would you educate the patient on how to discontinue an ADHD medication? Abrupt withdrawal can cause irritability and rebound symptoms after prolonged use. Medication needs to be tapered via PMHNP. If a patient's parent asked if their childs ADHD medication had a high possibility for addiction, what would you say? Several stimulant medications are classified as Schedule II indicating that they have a high potential for abuse. The PMHNP must adhere to federal and state-specific guidelines for prescribing these medications. Careful monitoring is required. Occasional urine drug screens should be obtained to verify the presence of amphetamines and the absence of other substances of abuse. What type of stimulants are at the highest risk for abuse or diversion? Ritalin, Adderall and Dexedrine short-acting medications are at higher risk for diversion (Short-acting medications for ADHD that are considered high risk for diversion include methylphenidate (Ritalin), mixed amphetamine salts (Adderall), and dextroamphetamine (Dexedrine), as they take effect quickly and wear off relatively fast, making them more susceptible to misuse and potential for diversion.) Sustained release medications are better for preventing this. What are some common side effects of stimulants? restlessness, irritability, anxiety, insomnia, stomachache, headaches, tics, and worsening aggression symptoms a worsening of symptoms or "crash" may occur when the medication wears off, especially with immediate-release (IR) medications What is the best way to avoid anorexia when taking a stimulant? take medication with breakfast to decrease anorexia or associated weight loss For younger children under the age of ______ the American Academy of Pediatrics (AAP) recommends ________ in behavior management as a first-line intervention for psychotherapy with ADHD. 6!!!!!! PARENT TRAINING Review what parents teaching parents receive when they participate in parent training: · Positive Communication · Positive Reinforcement · Structure and Discipline Behavior therapy, given by parents, teaches children to better control their own behavior, leading to improved functioning at school home and in relationships. Learning and practicing behavior therapy requires time and effort, but has lasting benefits for the child. In older children and adolescents, treatment often involves both medication and psychotherapy. Psychotherapeutic interventions may include cognitive-behavioral therapy (CBT), social and organizational skill training, and family therapy. What is the DSM-5 for O.D.D.? A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms of the following categories, and exhibited during interaction with at least one individual who is not a sibling:Angry/Irritable Mood Often loses temper Is often touchy or easily annoyed 3. Is often angry and resentful Argumentative/Defiant Behavior 4. Often argues with authority figures or, for children and adolescents, with adults 5. Often actively defies or refuses to comply with requests from authority figures or with rules 6. Often deliberately annoys others 7. Often blames others for his or her mistakes or misbehavior Vindictiveness 8. Has been spiteful or vindictive at least twice within the past 6 months. What is the frequency of symptoms needed for an official diagnosis of O.D.D? The symptoms have to present ONCE a week for at least 6 months for people 5 years and older If they are under 5 then the symptoms have to occur on most days for 6 months ODD can occur with ADHD and usually precedes a conduct disorder. __________ is characterized by severe behaviors that violate societal norms or the rights of others and may involve aggression towards others, animals, theft, and/or the destruction of property. Behaviors associated with Conduct disorder may present as early as pre-school, though more serious symptoms tend to appear later in childhood or adolescence before the age of 16. Behaviors often occur in MULTIPLE SETTINGS and frequently cause significant dysfunction. CONDUCT DISORDER! What is the DSM-5 for conduct disorder? 3 or MORE of the following symptoms within 12 months with one symptoms occurring within the last 6 months. Must cause significant impairment and must not met criteria for antisocial personality disorder. There is a childhood onset, adolescent onset and unspecified-onset subtype when the age at onset is unknown. Aggression to People and Animals; · Bullies, threatens, or intimidates others · Initiates physical fights · Uses a weapon · Physically cruel to people or animals · Theft with confronting a victim · Forces another into sexual activity · Lack of remorse · Early use of drugs Destroys Property · Uses arson to destroy property · Uses methods other than arson to destroy property Deceitfulness or Theft · Vandalism · Lies to obtain goods or favors · Theft without confronting a victim Serious Violations of Rules · Stays out at night, before aged 13 · Runs away from home overnight at least twice · Truant from school, before aged 13 What are some risk factors associated with conduct disorder? Difficult infant temperament and lower-than-average intelligence, Family-level risk factors include caregiver abuse and neglect varying caregivers or child-rearing practices, harsh discipline family criminality substance-related disorders Community-level risk factors include rejection by peers participation in a delinquent peer group, poverty exposure to violence Family members with conduct disorder depressive and bipolar disorders schizophrenia ADHD substance use disorders Comorbidities: Although many individuals with conduct disorder adjust socially and occupationally as adults, others have an increased risk of criminal behaviors and substance-related disorders, especially those with childhood-onset type. Individuals with conduct disorders are also at risk for mood and anxiety disorders, impulse-control disorders, psychotic disorders, and posttraumatic stress disorder (APA, 2022). The prevalence of conduct disorder is between 1.5% and 3.4% in the U.S. and tends to occur more frequently in males. What is the DSM-5 for intermittent explosive disorder? These people have a low tolerance for frustration and adversity. Recurrent behavioral outburst representing a failure to control aggressive impulses as manifested by either of the following: Verbal aggression (e.g., temper tantrums, tirades, verbal arguments or fights) or physical aggression toward property, animals, or other individuals, occurring TWICE WEEKLY, on average, for a period of THREE months. The physical aggression does not result in damage or destruction of property and does not result in physical injury to animals or other individuals. 3 behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period Outbursts are unplanned, have a rapid onset, are out of proportion to the trigger that elicited the response, and lasts no longer than 30 minutes o The outbursts can lead to subjective distress or social, occupational dysfunction and poor life satisfaction and quality of life for the affected individuals. How would you diagnose intermittent explosive disorder or any other conduct or impulse control disorder? Diagnosis of disruptive, impulse-control, and conduct disorders involves a comprehensive psychiatric evaluation including information about family history and parenting styles. Providers should also obtain a developmental history and academic records. Symptom-specific instruments for disruptive disorders include child-rated, caregiver-rated, and clinician-rated tools. What is the Minnesota Impulse Disorders Interview? This is a SCREENING interview that helps to SCREEN impulse control disorders. Remember, a comprehensive assessment is necessary for diagnosis. The higher the score on the MIDI, the more likely you are to have the impulse disorder. It is based on a 0-4 scoring What is the treatment for these impulse disorders, or conduct disorders? Management of disruptive disorders focuses on reducing positive reinforcement for undesirable behaviors, encouraging prosocial behaviors, using nonviolent forms of discipline, and following consistent parenting strategies (Fariba & Gokarakonda, 2021). __________ is recommended for children aged 3-11 years and their families. It provides psycho-education about the disorder and support for caregivers. Group parent-caregiver training programs: __________ is recommended when a child's behavior is extreme or complex and requires individualized attention to meet the family's unique circumstances. Individual parent-caregiver training Group child-focused programs are recommended for children aged 9-14 years to enhance social and problem-solving skills. What are cognitive problem-solving skills training? Recommended for children to help them see situations differently and respond appropriately. What are school-based programs? recommended for children and adolescents to help them relate to peers and improve school performance. What medication is FDA approved to treat DISRUPTIVE, IMPULSE CONTROL AND CONDUCT DISORDERS? Currently, there is no FDA-approved treatment for disruptive disorders; however, pharmacologic management can help reduce symptom burden, especially in children with comorbid conditions such as attention-deficit/hyperactivity disorder (ADHD). In situations that involve non-amenable aggression, providers may choose to prescribe mood stabilizers, antidepressants, or atypical antipsychotics What is fetal alcohol spectrum disorder? Fetal alcohol spectrum disorder (FASD) is an umbrella term that describes the physical, mental, behavioral, and/or learning disabilities that can occur in an individual who was PRENATALLY exposed to alcohol. What is fetal alcohol syndrome? Fetal alcohol syndrome (FAS) is the most involved diagnosis on the spectrum, assigned to individuals who have several physical and developmental abnormalities Name some facial features of individuals who have fetal alcohol syndrome? o Skin folds at the corner of the eye o Small head circumference o Low nasal bridge o Small eye opening o Short nose o Small midface o Indistinct philtrum o Thin upper lip o Prenatal growth deficits o Vision and hearing problems o Poor motor skills and coordination o Problems with heart, bones and kidneys o Short stature and low body weight REMEMBER: One of the requirements for the diagnosis of the most severe forms of FASD, FAS, and pFAS, requires the presence of facial dysmorphia, including narrow eyes, a smooth philtrum between the nose and mouth, and a thin upper lip (NIAAA, 2021). Many providers focus on the presence of facial characteristics in the diagnostic process; however, most children with FASD do not display facial dysmorphia. As many as 80.1% of children with FASD are missed and 6.4% are misdiagnosed when children are diagnosed primarily based the presence of physical markers. When diagnosing FASD, providers should be sure to consider the full scope of neurobehavioral deficits Name some functional difficulties that individuals diagnosed with fetal alcohol syndrome may exhibit? Difficulties with sleep and feeding in infancy, Performing daily life skills including feeding, bathing, counting money telling time minding personal safety Difficulties with self-care o Problems with memory and learning, especially MATH, poor reasoning and limited executive function, problems with attention and intellectual disability Name some behavioral difficulties that individuals diagnosed with fetal alcohol syndrome may exhibit? Poor social skills- Poor emotional control Impulsivity Hyperactivity Name some cognitive difficulties that individuals diagnosed with fetal alcohol syndrome may exhibit? Prenatal growth deficits Poor motor skills and coordination Vision and hearing problems Problems with heart, bones, kidneys Short stature and low body weight Small head size Abnormal facial features Name some physical difficulties that individuals diagnosed with fetal alcohol syndrome may exhibit? Prenatal growth deficits Poor motor skills and coordination Vision and hearing problems Problems with heart, bones, kidneys Short stature and low body weight Small head size Abnormal facial features Name some cognitive difficulties that individuals diagnosed with fetal alcohol syndrome may exhibit? Problems with memory and learning, especially math Poor reasoning and limited executive function Problems with attention Intellectual disability switching between tasks anxiety and depression What are some behavioral indications which can aid children with FAS? Behavioral interventions and training in social skills, problem-solving, and personal safety can assist students in improving social and functional skills. School-based interventions, such as speech and occupational therapy, behavioral supports, and accommodations are often indicated. Family support groups and parent education are also helpful. What are the benefits of early intervention concerning FAS? FASD treatment is based on the severity of symptoms and developmental impact. Prognosis is best if children receive a diagnosis and begin treatment before the age of six (MedlinePlus, 2021). Early intervention services can help children develop basic skills such as walking, talking, and interacting with others. what is the PMHNPs' role in identifying early with diagnosis for Individuals Disabilities Education Act (IDEA) of 1975? Psychiatric mental health nurse practitioners (PMHNPs) may be instrumental EARLY identifying diagnoses that qualify children for services. PMHNPs can provide education to parents about their rights under the law, provide documentation to support the creation of IEPs or 504 plans, and advocate for services for children. PMHNPs may also work directly with teachers and school personnel to identify strategies to help children function in the educational setting. This federal law designed to ensure that children who have disabilities receive free appropriate public education (FAPE). IDEA ensures that (U.S Department of Education, n.d.): Children with an identified disability receive individualized special education and services that address their needs. Children with disabilities receive preparation for employment and independent living. Children and families impacted by disability are protected under the law. Federal agencies, states, localities, and educational service agencies that provide educational assistance to children with disabilities receive support. Section 504 of the Rehabilitation Act of 1973 also protects the rights of individuals with disabilities who are enrolled in programs receiving federal financial assistance through the U.S. Department of Education (2020). Support is typically provided through the implementation of Individualized Education Plans (IEP) or 504 plans, which describe the services and accommodations that will be provided to students with qualifying disabilities. Although schools are responsible for identifying and providing appropriate education and services for children with disabilities, there is wide variation in the degree to which school districts provide timely, accurate information and support to children and parents. Prognosis for FAS is best if children receive a diagnosis and begin treatment before the age of_____. SIX!! Discuss pharmacological treatment for fetal alcohol syndrome. Treatment often combines pharmacological and nonpharmacological approaches. Pharmacological interventions may include selective serotonin reuptake inhibitors (SSRIs) antidepressants, alpha2 agonists, anticonvulsants, stimulants, and atypical antipsychotics (Mela et al., 2020). Lastly, how would you diagnose fetal alcohol syndrome? The process of diagnosing FASD can be complex. There is no specific test for FASD. Because symptoms resemble those of other diagnoses such as ADHD, ODD, or conduct disorder, children may be misdiagnosed leading to delays in treatment. Diagnosis is based on confirmation of maternal alcohol consumption!!!!!!!! however, this can create challenges in diagnosis for children who are adopted with a limited available family history or whose parents may be poor historians. To obtain an accurate diagnosis, input from professionals from several disciplines is usually required. An interdisciplinary evaluation may include collaboration with a primary care provider, developmental pediatrician, geneticist, psychologist, social worker, speech-language pathologist, occupational therapist, or educational specialist (Zoorob, n.d.). Eating disorders typically develop in adolescence or young adulthood, and while they are more common in women, they can affect all genders and races at any age. Name some risk factor for Eating Disorders o Family history that includes a close relative with an eating disorder o Weight stigma in the culture or family o trauma (especially physical or sexual abuse) o History of being bullied about weight or physical appearance may increase the risk for eating disorders. o Clients with eating disorders sometimes present with a negative, subjective appraisal of themselves, perfectionism, body image dissatisfaction, and a history of an anxiety disorder. Complex biopsychosocial factors influence the development of eating disorders. Individuals with eating disorders may experience neurobiological differences involving ______ AND ______. Serotonin and Dopamine