NURS 6660 MID TERM EXAM 2 2022 WITH ANSWERS

. Which of the following statements is true with respect to children who present to care acutely due to violent, enraged behavior? 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: 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: 4. Treatment of abused children is multimodal and long term. The single most important aspect of treatment is: 5. Having child and adolescent patients rate their feelings and moods on a scale of 1–10 is most effective in which age group? 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: 7. What is the primary diagnostic difference between obsessive-compulsive disorders in children as compared to adults? 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: 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: 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: 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: 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? 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: 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? 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: 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: 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: 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: 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: 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: 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: 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 assessm