NR606 MIDTERM EXAM STUDY GUIDE
QUESTIONS AND SOLUTIONS 100 PERCENT
CORRECT VERIFIED ANSWERS
●● What are some barriers that pregnant women are faced with when
attempting to seek care for mental health?
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.
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.
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.
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.
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
Answer:
,●● How does consent work with children?
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?
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
, 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?
Answer: The Child Abuse Prevention and Treatment Act
●● What are some prescribing considerations for women who are
pregnant?
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
QUESTIONS AND SOLUTIONS 100 PERCENT
CORRECT VERIFIED ANSWERS
●● What are some barriers that pregnant women are faced with when
attempting to seek care for mental health?
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.
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.
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.
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.
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
Answer:
,●● How does consent work with children?
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?
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
, 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?
Answer: The Child Abuse Prevention and Treatment Act
●● What are some prescribing considerations for women who are
pregnant?
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
