NR 606 Midterm Exam QUESTIONS AND
CORRECT ANSWERS
What are barriers to seeking mental health care in children & adolescents? - CORRECT
ANSWER Children- Although children and adolescents may seek help, they usually
drop out before treatment is effective due to poverty, language barriers, living in communities
with lack of resources, stressors such as family issues, violence in the community, unstable
housing, unemployment and food insecurity.
Adolescents- Many parents lack an access to sufficient care for their children or themselves
during perinatal. Parents and adolescents are reluctant to receive care due to the stigmas or
negative perceptions towards mental health services.
What are some barriers that pregnant women are faced with when attempting to seek care for
mental health? - CORRECT ANSWER Perinatal- cost, scheduling conflicts and high
staff turnover rate causes issues for families seeking care.
Less than 15% of women get treated for PPD.
Explain the sensorimotor stage (ages 0-2) according to Piaget. - CORRECT
ANSWER Children experience the world through their senses and motor responses.
The goal of this stage is object permanence.
Explain the pre-operational stage (ages 2-7) according to Piaget. - CORRECT
ANSWER Children think symbolically and think very concrete. They learn to use
words or pictures to represent objects. They are egocentric and have difficulty seeing things
from others' perspectives. Pre-operational thinking is very concrete. So think very straight
forward when you are teaching them:
"You know how its hard for you to sit still and pay attention in school? This medicine will
help you" . Imagination is still strong however abstract thinking is difficult. Think Ade's
responses. THE ABSENCE OF OBJECT PERMANENCE.
Explain the concrete-operational stage (ages 7-11) according to Piaget. - CORRECT
ANSWER Children begin to think more logical and organized about concrete events.
,They begin to reason inductively, from specific information to principles. Using similes
within teaching is great for this group.
"It's kind of like you've got a great bike. The brakes just need some fixing. The medication is
like fixing the brakes." Time, space, and quantity is understood however not as separate
concepts.
Explain the Formal-operational stage (ages 12 and up) according to Piaget. - CORRECT
ANSWER Adolescents and young adults begin to reason abstractly and can consider
hypothetical problems. They begin to think more about moral, philosophical, ethical, social,
and political issues.
"This medication can help you ignore distractions so you can complete tasks. They can also
help with self-control, which may help you get along better with your friends and parents. Do
you have any concerns about taking the medication?" They begin to start planning at this age.
-50% of lifetime mental illnesses begin at the age of 14.
-50% of children ages 8-15 are not treated for mental illnesses - CORRECT ANSWER
How does consent work with children? - CORRECT ANSWER Parents may decide
whether to allow treatment if the child is unable to provide true informed consent (Preston et
al., 2021). Although children may not be able to give legal consent, they should be included
in discussions about medication and treatment whenever possible. Child input into treatment
decisions may encourage treatment adherence. Positive experiences with providers and
treatment can help instill the perception that treatment is beneficial, which can support
positive mental health behaviors in the future.
What should be included in the consent form and documentation when discussing
information (such as taking psychotropic drugs) with pregnant patients? - CORRECT
ANSWER Informed consent should include
side effects
possible/rare side effects to mother and baby regardless of incidence
the patient's decision to continue or discontinue treatment
potential risks of continuing or discontinuing treatment
Referral to perinatal psychiatrist if the patient is at high risk or on a high-risk medication.
,What are some points that PMHNP should take into consideration when prescribing
medications for children?
Metabolism, Excretion, Side effects - CORRECT ANSWER Metabolism- Children
have a higher metabolism than adults and may require higher dose of medication per body
weight. When they reach puberty in adolescents is when the medication is usually titrated
down because they are reaching a metabolism of an adult.
Excretion- Children are going to excrete medications quicker due to high metabolism. Ensure
to use proper prescribing protocol per weight. Again, may need higher doses than adults.
Side effects- Children may not understand that they are experiencing side effects so the
PMHNP must ensure to educate and include the child in prescribing education as well as be
keen to side effects that the child may or may not describe. (Listen to the parents as well).
Allow children to participate in the treatment plan
PMHNP are mandatory reporters and MUST report any forms of child abuse, neglect or
suspicions of such to the authorities. There are federal and state guidelines that we are
expected to follow. What is this federal guideline called? - CORRECT ANSWER The
Child Abuse Prevention and Treatment Act
What are some prescribing considerations for women who are pregnant? - CORRECT
ANSWER The physiologic changes that occur during pregnancy impact the
pharmacokinetics of many medications. An increase in blood plasma level may increase the
distribution volume of certain medications. Hormonal changes in CYP450 enzyme
activations may increase or decrease drug metabolism. Increased renal blood flow and
glomerular filtration rate may speed the excretion of medications. Monitoring of serum drug
levels can help inform drug dosing for some medications; generally, however, providers must
rely on careful symptom monitoring and adjust dosages as necessary to achieve optimal
symptom management at the lowest beneficial dose (Payne, 2020).
_______ stigma includes policies, regulations, or laws that intentionally or unintentionally
lead to discrimination. This stigma can limit access to resources and other opportunities,
thereby impacting the well-being of the stigmatized group.
A program policy that prohibits individuals from using specific forms of prescribed
medication for addiction (MAT) treatment is an example of structural stigma. - CORRECT
ANSWER Institutional or structural stigmas
_____ stigma is when Individuals working in [medication-assisted treatment] MAT
experience discrimination and prejudice from other healthcare professionals, especially
, abstinent treatment professionals who disagree with the use of medications to treat opioid use
disorders.
This discrimination and prejudice stem at times from stigma toward addiction diagnoses, and
at other times toward unique features of MAT itself. The experiences of addiction treatment
professionals illustrate how medical interventions can mark clients and professionals in ways
that affect client care, and thus must be added to the scope of destigmatization efforts" (p.
324). - CORRECT ANSWER Interventional stigmas
_______ stigma encompasses the attitudes, beliefs, and behaviors of groups or individuals
which form a stereotype that creates an emotional reaction or prejudice and results in
discrimination.
A stereotypic belief that individuals choose to use alcohol or other drugs and blame them for
their substance use disorder is an example of this stigma. - CORRECT
ANSWER Public stigma
_______ stigma refers to the shame individuals internalize about negative stereotypes. For
individuals affected by SUDs, this stigma may lead to feelings of being flawed or unworthy
of love or connection. It may also prevent them from seeking help. - CORRECT
ANSWER self-stigma
Name some risk factors for maternal mental health disorders: - CORRECT
ANSWER lack of social support
familial/personal history of depression
pregnancy complications
poor relationship quality
smoking
unintended pregnancy
life complications
chronic physical conditions
prior pregnancy with infant/fetal loss
What is the DSM-5 criteria for maternal depression? - CORRECT ANSWER The
patient has to have at least 5 symptoms for a two week period to be diagnosed with MDD.
CORRECT ANSWERS
What are barriers to seeking mental health care in children & adolescents? - CORRECT
ANSWER Children- Although children and adolescents may seek help, they usually
drop out before treatment is effective due to poverty, language barriers, living in communities
with lack of resources, stressors such as family issues, violence in the community, unstable
housing, unemployment and food insecurity.
Adolescents- Many parents lack an access to sufficient care for their children or themselves
during perinatal. Parents and adolescents are reluctant to receive care due to the stigmas or
negative perceptions towards mental health services.
What are some barriers that pregnant women are faced with when attempting to seek care for
mental health? - CORRECT ANSWER Perinatal- cost, scheduling conflicts and high
staff turnover rate causes issues for families seeking care.
Less than 15% of women get treated for PPD.
Explain the sensorimotor stage (ages 0-2) according to Piaget. - CORRECT
ANSWER Children experience the world through their senses and motor responses.
The goal of this stage is object permanence.
Explain the pre-operational stage (ages 2-7) according to Piaget. - CORRECT
ANSWER Children think symbolically and think very concrete. They learn to use
words or pictures to represent objects. They are egocentric and have difficulty seeing things
from others' perspectives. Pre-operational thinking is very concrete. So think very straight
forward when you are teaching them:
"You know how its hard for you to sit still and pay attention in school? This medicine will
help you" . Imagination is still strong however abstract thinking is difficult. Think Ade's
responses. THE ABSENCE OF OBJECT PERMANENCE.
Explain the concrete-operational stage (ages 7-11) according to Piaget. - CORRECT
ANSWER Children begin to think more logical and organized about concrete events.
,They begin to reason inductively, from specific information to principles. Using similes
within teaching is great for this group.
"It's kind of like you've got a great bike. The brakes just need some fixing. The medication is
like fixing the brakes." Time, space, and quantity is understood however not as separate
concepts.
Explain the Formal-operational stage (ages 12 and up) according to Piaget. - CORRECT
ANSWER Adolescents and young adults begin to reason abstractly and can consider
hypothetical problems. They begin to think more about moral, philosophical, ethical, social,
and political issues.
"This medication can help you ignore distractions so you can complete tasks. They can also
help with self-control, which may help you get along better with your friends and parents. Do
you have any concerns about taking the medication?" They begin to start planning at this age.
-50% of lifetime mental illnesses begin at the age of 14.
-50% of children ages 8-15 are not treated for mental illnesses - CORRECT ANSWER
How does consent work with children? - CORRECT ANSWER Parents may decide
whether to allow treatment if the child is unable to provide true informed consent (Preston et
al., 2021). Although children may not be able to give legal consent, they should be included
in discussions about medication and treatment whenever possible. Child input into treatment
decisions may encourage treatment adherence. Positive experiences with providers and
treatment can help instill the perception that treatment is beneficial, which can support
positive mental health behaviors in the future.
What should be included in the consent form and documentation when discussing
information (such as taking psychotropic drugs) with pregnant patients? - CORRECT
ANSWER Informed consent should include
side effects
possible/rare side effects to mother and baby regardless of incidence
the patient's decision to continue or discontinue treatment
potential risks of continuing or discontinuing treatment
Referral to perinatal psychiatrist if the patient is at high risk or on a high-risk medication.
,What are some points that PMHNP should take into consideration when prescribing
medications for children?
Metabolism, Excretion, Side effects - CORRECT ANSWER Metabolism- Children
have a higher metabolism than adults and may require higher dose of medication per body
weight. When they reach puberty in adolescents is when the medication is usually titrated
down because they are reaching a metabolism of an adult.
Excretion- Children are going to excrete medications quicker due to high metabolism. Ensure
to use proper prescribing protocol per weight. Again, may need higher doses than adults.
Side effects- Children may not understand that they are experiencing side effects so the
PMHNP must ensure to educate and include the child in prescribing education as well as be
keen to side effects that the child may or may not describe. (Listen to the parents as well).
Allow children to participate in the treatment plan
PMHNP are mandatory reporters and MUST report any forms of child abuse, neglect or
suspicions of such to the authorities. There are federal and state guidelines that we are
expected to follow. What is this federal guideline called? - CORRECT ANSWER The
Child Abuse Prevention and Treatment Act
What are some prescribing considerations for women who are pregnant? - CORRECT
ANSWER The physiologic changes that occur during pregnancy impact the
pharmacokinetics of many medications. An increase in blood plasma level may increase the
distribution volume of certain medications. Hormonal changes in CYP450 enzyme
activations may increase or decrease drug metabolism. Increased renal blood flow and
glomerular filtration rate may speed the excretion of medications. Monitoring of serum drug
levels can help inform drug dosing for some medications; generally, however, providers must
rely on careful symptom monitoring and adjust dosages as necessary to achieve optimal
symptom management at the lowest beneficial dose (Payne, 2020).
_______ stigma includes policies, regulations, or laws that intentionally or unintentionally
lead to discrimination. This stigma can limit access to resources and other opportunities,
thereby impacting the well-being of the stigmatized group.
A program policy that prohibits individuals from using specific forms of prescribed
medication for addiction (MAT) treatment is an example of structural stigma. - CORRECT
ANSWER Institutional or structural stigmas
_____ stigma is when Individuals working in [medication-assisted treatment] MAT
experience discrimination and prejudice from other healthcare professionals, especially
, abstinent treatment professionals who disagree with the use of medications to treat opioid use
disorders.
This discrimination and prejudice stem at times from stigma toward addiction diagnoses, and
at other times toward unique features of MAT itself. The experiences of addiction treatment
professionals illustrate how medical interventions can mark clients and professionals in ways
that affect client care, and thus must be added to the scope of destigmatization efforts" (p.
324). - CORRECT ANSWER Interventional stigmas
_______ stigma encompasses the attitudes, beliefs, and behaviors of groups or individuals
which form a stereotype that creates an emotional reaction or prejudice and results in
discrimination.
A stereotypic belief that individuals choose to use alcohol or other drugs and blame them for
their substance use disorder is an example of this stigma. - CORRECT
ANSWER Public stigma
_______ stigma refers to the shame individuals internalize about negative stereotypes. For
individuals affected by SUDs, this stigma may lead to feelings of being flawed or unworthy
of love or connection. It may also prevent them from seeking help. - CORRECT
ANSWER self-stigma
Name some risk factors for maternal mental health disorders: - CORRECT
ANSWER lack of social support
familial/personal history of depression
pregnancy complications
poor relationship quality
smoking
unintended pregnancy
life complications
chronic physical conditions
prior pregnancy with infant/fetal loss
What is the DSM-5 criteria for maternal depression? - CORRECT ANSWER The
patient has to have at least 5 symptoms for a two week period to be diagnosed with MDD.
