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2021 NURS6660 Walden University Clinical Analysis Final Exam With Answers (75 Solved Questions)

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Walden University
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1 WALDEN UNIVERSITY NURS 6660 FINAL EXAM Question 1 In which demographic is depression twice as prevalent in girls as compared to boys? A. Preschoolers B. School aged C. Adolescents D. All children Question 2 Andrew is a 14 - year - old male who is being managed for bipolar I dis order. He was started on lithium 6 weeks ago and has achieved a serum level of 1.1 mEq/L according to his most recent blood work. Andrew says he does not feel any different, but both his parents and teachers report improvement in his mood. He has been more stable, is getting along better with friends and siblings, and is even more interested in his schoolwork. The PMHNP plans to maintain Andrew on this medication and knows that he will need which of the following ongoing laboratory assessments? A. Comple te blood count, thyroid function tests, and serum calcium B. Liver function tests, complete blood count, and 12 - lead electrocardiogram C. White blood cell differential, fasting glucose, and fasting lipid profile D. Comprehensive metabolic panel , complete blood count, and thyroid function tests Question 3 Confidentiality is a complex topic in the world of child and adolescent psychiatry. The last 40 to 50 years have been characterized by increased attention to this issue and the publication of various ethical codes and practice position statements by professional organizations. Which of the following is not a true statement with respect to confidentiality of the child or adolescent client? A. The PMHNP should not be concerned with consen t for disclosure when child abuse or maltreatment has occurred.
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2 B. In 1979, the American Psychiatric Association (APA) stated that children 12 years of age or older can give consent for disclosure. C. The American Academy of Child and Adolescent Ps ychiatry (AACAP) Code of Ethics
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3 states that consent is not required for disclosure. D. Regardless of code or position statement by any organization, the best approach is when the child and PMHNP agree on disclosure. Question 4 Debi is a 15 - year - old girl who is currently being treated for depression. Her parents have been very proactive and involved in her care, and Debi has achieved remission 2 months after beginning treatment with a combination of pharmacotherapy and cognitive behavioral t herapy. While counseling Debi’s parents about important issues in management, the PMHNP advises that: A. There is a > 50% likelihood that Debi’s younger sibling will develop depressive symptoms B. The mean length of major depressive episode in adole scents is 4 months C. 20 to 40% of adolescents who have major depressive disorder will develop bipolar I within 5 years D. Adolescent - onset depression typically needs long - term pharmacologic management to prevent relapse Question 5 The therap eutic outcomes for children with disorders of written expression are most favorable when they are characterized by: Concomitant pharmacotherapy with a psychostimulant to promote attention and focus Multimodal therapy to include group interaction wit h peer - to - peer feedback on writing samples A variety of tutors who will offer a variety of writing techniques, composition strategies, and critiques Intensive, continuous administration of individually tailored, one - on - one expressive and creative w riting therapy
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4 Question 6 When considering a diagnosis of developmental coordination disorder, the PMHNP knows that the diagnosis may be associated with: A. Above - average scores on performance subtests of standardized intelligence testing B. Be low - average scores on verbal subtests of standardized intelligence testing C. Soft neurologic signs on physical examination such as slight reflex abnormalities D. Physical findings consistent with neuromuscular disease such as muscular dystrophy Question 7 Caylee is a 5 - year - old girl who is referred for evaluation by child protective services. She was recently removed from her biological family and placed in foster care, as her home environment was reportedly unsafe due to conditions of extre me neglect. Her foster mother reports that Caylee is very quiet and withdrawn and always appears sad and disinterested in her surroundings; however, she becomes very irritable when anything unexpected or unplanned occurs. The foster mother became very conc erned when it appeared that Caylee was hallucinating. The PMHNP considers that: A. Caylee is at high risk for suicide and precautions should be taken B. The hallucinations are consistent with brief psychotic disorder or schizophrenia C. The hist ory and reported symptoms are typical of depressive disorder in young children D. This is a common situation when prepubertal children are removed from the biological parents regardless of how dysfunctional they are
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5 Question 8 Children with gender d ysphoria typically have higher rates of all the following except: A. Depression B. Impulse control disorders C. Anxiety disorders D. Eating disorder Question 9 Eileen is a 23 - month - old girl who is being evaluated for autism spectrum disorder because her pediatrician is concerned about the presence of developmental red flags. She has just a few words of speech and has not put together any meaningful two - word phrases. While taking a history from Eileen’s mother the PMHNP learns that for approximately the last 2 months Eileen has been seen eating paint chips that are peeling off the baseboard and window sills in the family home; when she sees one she puts it in her mouth. This is a concern because they live in an old farmhouse and there m ay be lead - based paint in some of the paint layers. The PMHNP considers that which of the following is not consistent with a diagnosis of pica? A. A diagnosis of autism spectrum disorder B. Symptoms < 6 months duration C. The pattern of eating D. Lack of potential consequences Question 10 The current scholarly consensus is that the etiology of bulimia nervosa is multifactorial to include biological, sociocultural, family, cognitive - behavioral, and psychodynamic factors. When considerin g the etiology of bulimia nervosa, the PMHNP understands that:
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6 A. Family factors contributing to bulimia nervosa include emotional restraint, tight parental control of behavior, and avoidance of conflict. B. Lowered serotonin activity is seen in th e brains of patients with bulimia nervosa. C. There is a disproportionate incidence in childhood sexual abuse in patients with bulimia nervosa. D. Cultural influences are much less implicit in the development of bulimia nervosa as compared to anore xia nervosa. Question 11 Standardized instructional programs used in the management of reading disorders include all the following except: A. The Orton Gillingham and Direct Instructional System for Teaching and Remediation B. Science Resea rch Associates, Inc. Basic Reading Program C. Bridge Reading Program D. Woodcock - Johnson Psychoeducational Battery Question 12 Which of the following symptom clusters is most likely in a 16 - year - old male with major depressive disorder? A. Disturbance of mood, loss of interest, and mood - congruent hallucinations B. Irritability, persistent abdominal complaints, and insomnia C. Decreased concentration, social withdrawal, and substance abuse D. Pervasive anhedonia, hopelessness, an d severe psychomotor retardation
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7 Question 13 The PMHNP is working with rural primary care providers to increase awareness of mental health disorders in infancy and early childhood. The program includes a session on screening for feeding disorders in i nfants. If an infant is either observed by the provider or reported by the parent to frequently suck the tongue rhythmically or appear to strain with his or her back arched and then swallow, the examiner should consider the possibility of: A. Gastroesop hageal reflux disease B. Failure to thrive C. Iron deficiency D. Inadequate emotional attachment Question 14 An astute pediatrician has referred Kyle, a 5 - month - old infant, for evaluation of rumination disorder. His mother was concerned because he seemed to “want” to regurgitate every time he ate and would even seem to “put his hand down his throat” in order to stimulate regurgitation. Kyle had a thorough evaluation and according to the pediatrician did not have gastroesophageal reflux or hiatal hernia. The mother - infant relationship appeared to be healthy and, via assessment, the PMHNP could not identify any clear emotional issues. The primary treatment strategy for Kyle will likely focus on: A. Aversive therapies, e.g., squirting lemo n juice into Kyle’s mouth when he ruminates B. Medication therapies to include trials of first - line agents such as metoclopramine, cimetidine, or haloperidol C. Psychotherapy for the parents D. Habit - reversal therapies
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8 Question 15 The lit erature indicates that boys whose fathers died before the age of 13 are at a greater risk for the development of depression as compared to controls. This is consistent with which general theory of depression etiology? A. Molecular - genetic B. Biolog ic C. Psychosocial D. Stress - diathesis Question 16 Katelyn is a16 - year - old girl who presents for therapy with her mother and father. Katelyn was born with male genitalia but has felt like a female “all of her life.” She says she knew somethi ng was different as far back as she can remember. She always wanted to wear her mother’s clothes and makeup and play with other girls. Katelyn started dressing and openly identifying as a girl when she was 13 years old, and her parents are trying to be sup portive but they are struggling. Most recently Katelyn has developed an intimate partner relationship with Jennifer, a 15 - year - old girl who was gender - assigned female at birth and identifies as a female. Katelyn’s father does not understand the relationsh ip. The PMHNP explains that Katelyn: A. Is responding to the male hormonal surges of puberty and will ultimately identify with her physiologic gender B. Does not have a clear sense of gender identity and may be a candidate for reparative therapy to correct her gender identity issues C. Is a transgender female who identifies as lesbian D. Is a heterosexual male with transvestic disorder Question 17
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9 All of the following are proposed etiologies of pica except: A. Nutritional deficienc ies
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10 B. Parental neglect C. Compensation for oral needs D. Autism spectrum disorder Question 18 Christine is a 9 - year - old female who presents for care after having been placed in the local foster care system. She has been in and out of foster care for the last 4 years after her parents were killed in an automobile accident. Christine has been placed in a variety of homes and residential care facilities. The PMHNP recognizes that Christine is at high risk for: A. Dissociative disorders B. Post - traumatic stress disorder C. Impulse - control disorder D. Attachment disorder Question 19 While the core features of schizophrenia are essentially the same in children as they are in adults, the presentation or characterization is sometimes very different given developmental issues. Unlike adults with schizophrenia, children with schizophrenia do not have: A. Classic positive symptoms B. Poverty of speech content C. Social rejection D. Delusions of persecution
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11 Question 20 The PMHNP is working with a couple who has been trying for years to conceive and is now ready to pursue adoption as an option. They are considering all possibilities; private vs. government - mediated adoption, adopting from another country, adopting a child of a different race or ethnicity, adopting an older child rather than an infant, and adopting a child who is currently in foster care vs. one who lives in an orphanage. While counseling this couple, the PMHNP advises them that: A. Young er children adopted from foster care settings have the best outcomes B. Children adopted from abuse and neglect situations have better psychological adaptation than those adopted as newborns C. Transracial adoptions have demonstrated greater disrup tions as compared to same - race adoptions D. Adoptions into families as an only child are more successful than those into families with biological children Question 21 Mel is a 15 - year - old male with a complex psychiatric assessment. He has a long history of mood instability, behavior problems, and trouble with schoolwork . He was an extremely active child who, at one time, was put on medication for hyperactivity. After a comprehensive evaluation, the PMHP recognizes that he meets diagnostic criteria for both bipolar I disorder and attention deficit hyperactivity disorder (ADHD). The most successful approach to his management is likely to begin with: A. Pharmacotherapy for ADHD B. Pharmacotherapy for bipolar I C. Parental training and behav ioral interventions for ADHD D. Family - focused psychoeducational (FFT - A) for bipolar I
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12 Question 22 Bruce and Debbie have made an appointment for a psychiatric consultation for what amounts to psychiatric genetic counseling. Bruce is 31 years old and Debbie is 28 years old. They have been married for 3 years and want to have children. Debbie is worried because she has a diagnosis of schizophrenia. Her symptoms first became evident when she was in her junior year of college; fortunately, she knew about the disease due to family history and sought care quickly. She has been very open with Bruce, and they are both well informed about the disease. Debbie is an only child and her father had schizophrenia that was not well controlled. He committed suicide wh en she was 15 years old. Debbie takes olanzapine and feels well overall. She has a part - time job, functions well, but is concerned about the genetic nature of her disease. Counseling for Bruce and Debbie includes which of the following pieces of informatio n? A. Schizophrenia is up to eight times more prevalent in first - degree relatives as compared to the general population. B. Schizophrenia has been isolated to chromosome number 5 and antenatal testing is available to predict genetic predisposition o f the fetus. C. Debbie’s age of onset is more highly correlated with incidence in her offspring as compared to early - onset schizophrenia. D. Environment is at least as important as genetics with respect to expression of schizophrenic symptoms. Question 23 The PMHNP is working with a pediatrician colleague on a journal article to increase awareness and improve diagnostic strategies for early - onset bipolar disorder. Based upon a review of the longitudinal research on this disorder, the litera ture review of this article should include all the following except: A. Recovery rates are lower when bipolar disorder has an early - childhood onset B. Early - onset bipolar disorder presents a greater likelihood of mixed states and rapid cycling as co mpared to adolescent and adult onset C. Higher socioeconomic status and lifetime psychosis are predictors of more rapid cycling in early - onset bipolar disorder D. There is a more frequent conversion from bipolar II to bipolar I in childhood as comp ared to adults
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13 Question 24 Treatment of early - onset schizophrenia can be challenging due to the paucity of evidence - based support for various pharmacotherapeutics and nonpharmacologic interventions. In a recent study comparing olanzapine to clozapin e, outcomes were assessed with the Clinical Global Impression of Severity of Symptoms Scale and Schedule for the Assessment of Negative/Positive Symptoms. Clozapine was found to demonstrate statistically significant superiority in which outcome measure? A. Alleviating negative symptoms B. Occurrence of extrapyramidal effects C. Sustained remission of symptoms D. Remission of hallucinations and delusions Question 25 Benjamin is a 4 - year - old male who is being evaluated because his mom is afraid that he may be schizophrenic. There is a history of schizophrenia in the mother’s family; her maternal aunt, one sister, and one of her brother’s children were all diagnosed with schizophrenia. Today she reports that Benjamin has episodes during wh ich he appears to be hallucinating. Sometimes he seems to see things that are not there, and other times he actually talks with and plays with imaginary people. The PMHNP continues to gather information from the mother and Benjamin and plans to do some obs ervation of Benjamin during play. When considering a diagnosis of early - onset schizophrenia, the PMHNP considers all of the following except: A. There are virtually no reports of schizophrenia onset before age 5 B. Hallucinations are significantly m ore predictive of schizophrenia than delusions in young children C. Benjamin’s symptoms are more likely a consequence of developmental immaturity D. Benjamin’s family history should always be considered, but at this point the diagnosis is very unli kely