Explain why Treatment of abused children is multimodal and long term.

Explain why Treatment of abused children is multimodal and long term.

Explain why Treatment of abused children is multimodal and long term.

Question 1

Which of the following statements is true with respect to
children who present to care acutely due to violent, enraged behavior?

A.

Under no circumstances should the PMHNP approach this
patient.

B.

Prepubertal children typically require medication as they
are too young to respond to conversation.

C.

Children who have a history of repeated, self-limited,
severe tantrums require at least a 72-hour admission.

D.

If the child appears to be calming down in the emergency
area, the clinician may ask the child for his version of events.

Question 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:

A.

A history of sexual abuse

B.

Fetal alcohol syndrome

C.

Early onset schizophrenia

D.

Social anxiety disorder

Question 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:

A.

A comprehensive medical assessment

B.

Standardized developmental measures

C.

Assessment without the parents present

D.

Observation of Jason during play

Question 4

Treatment of abused children is multimodal and long term.
The single most important aspect of treatment is:

A.

Establishing a safe place for the child

B.

Exposure related to the feared experience

C.

Psychoeducation

D.

Cognitive-behavioral interventions

Question 5

Having child and adolescent patients rate their feelings and
moods on a scale of 1–10 is most effective in which age group?

A.

18-months to 3 years

B.

3 to 5 years

C.

5 to 11 years

D.

12 to 17 years

Question 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:

A.

Review of a video recording of a nightmare event and Eric’s
immediate response

B.

Age-appropriate interview, e.g., ?If you had three wishes,
what would they be??

C.

Observation of Eric in a playroom where he is unaware that
he is being watched

D.

Partially open-ended questions that provide some focus but
allow expression of feeling

Question 7

What is the primary diagnostic difference between
obsessive-compulsive disorders in children as compared to adults?

A.

Age of onset

B.

Response to treatment

C.

Recognition that the thoughts or behaviors are irrational

D.

The thoughts or behaviors occupy > 1 hour daily

Question 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:

A.

Talk with the examiner via dolls

B.

Respond to open-ended questions

C.

Draw family members and peers

D.

Complete an MMPI

Question 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:

A.

Does not offer flexibility in understanding the evolution of
the problem

B.

Frequently deemphasizes the influence of environmental
factors

C.

May not systematically cover all psychiatric diagnostic
categories

D.

Creates a dialogue in which patients cannot give subjective
responses

Question 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:

A.

Neuropsychiatric assessment

B.

Biopsychosocial formulation

C.

The Physical and Neurological Examination of Soft Signs
(PANESS)

D.

Kaufman Assessment Battery for Children

Question 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:

A.

Anticipate that he can tolerate up to a 45-minute session

B.

Consider that symbolic play with dolls will be informative

C.

Interview him alone before involving the parents

D.

Be clear that he is there because of problem behavior

Question 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?

A.

The parents’ own emotional adjustments should be determined.

B.

The parents are usually more aware of symptoms than the
child.

C.

The parents may prefer to speak with the PMHNP separately.

D.

The parents’ upbringings are relevant to the child’s
diagnosis.

Question 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:

A.

These are common in the first weeks of therapy and the dose
should be increased to a therapeutic regimen

B.

Karen may be a poor metabolizer of CYP2D6 medications and
will need a change of therapy

C.

Behavioral modalities should be started as optimal
management of ADHD is multimodal

D.

Fluoxetine should be added to the regimen as it has
demonstrated efficacy with coincident anxiety

Question 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?

A.

Selective serotonin reuptake inhibitors (SSRI)

B.

SSRI in combination with CBT

C.

Coaching Approach behavior and Leading by Modeling (CALM)

D.

CALM in combination with a first-generation antihistamine

Question 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:

A.

The presence of imaginary play

B.

A failed hearing test

C.

Exaggerated response to minor injury

D.

Notable decrease in attachment behaviors

Question 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:

A.

Their own fears and anxieties

B.

Psychotic episodes they have experienced

C.

The chronology of symptom presentation

D.

Episodes of mood extremes

Question 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:

A.

Unresolved conflict as a fuel for aggressive behavior
targeting authority figures

B.

The concept that oppositionality is a reinforced, learned
behavior in which the child exerts control over authority figures

C.

A maladaptive response to parents’ modeling of conflict
avoidance as manifested by even-tempered responses to parent-toddler struggles

D.

That the behavior is reinforced by increased parental
attention in response to the undesirable behavior

Question 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:

A.

Most effective when paired with eye movement desensitization
and reprocessing (EMDR)

B.

Considered by experts to be the first-line management
approach for treatment of PTSD symptoms

C.

Very effective in individuals but generally not recommended
for group treatment, e.g., school-based traumas

D.

Gaining widespread acceptance as a first-line management
strategy for other forms of anxiety disorders

Question 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:

A.

Separation anxiety

B.

Social anxiety

C.

Generalized anxiety

D.

Specific phobia

Question 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:

A.

This is most consistent with early-onset schizophrenia

B.

An organic brain disorder should be ruled out

C.

These are normal findings in very young children

D.

Comprehensive psychiatric assessment is indicated

Question 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:

A.

Parent training

B.

Pharmacotherapy

C.

Time out

D.

Conflict avoidance

Question 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 assessment of Harmony includes
neuropsychiatric testing. The PMHNP documents the presence of neurological hard
signs. These suggest:

A.

Brain lesions

B.

Early-onset schizophrenia

C.

Low intelligence

D.

Learning disability

Question 23

Despite a wealth of data-based information on bullying,
including information about its forms, presenting symptoms, and consequences,
current research suggests that accurate information about bullying is not
influencing preventive and awareness strategies in most school systems. When
advising school personnel, parents, and primary care providers

about bullying, the PMHNP should emphasize that:

A.

Physical bullying has the most dangerous outcomes

B.

Bullying is more common in boys than girls

C.

Victims often develop alcohol abuse problems

D.

Verbal bullying is the most common form

Question 24

Wendy is a 6-year-old female being evaluated by the PMHNP
following a suicide attempt. The police were called when a neighbor saw Wendy
jump out of the open window of her first-floor apartment. She was unhurt, but
when the neighbor asked why she jumped out she said she wanted to kill herself.
Which coincident finding would warrant an inpatient psychiatric admission for
Wendy?

A.

This was not the first episode.

B.

The caretaker is incapable of arranging follow-up.

C.

One or both of the biological parents has a history of
suicide attempts.

D.

Wendy was left with a babysitter when the incident occurred.

Question 25

Psychiatric assessment of the adolescent patient is
different in several ways from assessment of younger children. While trying to
establish a therapeutic environment with an adolescent who is openly hostile,
one of the most important things the PMHNP can do is to:

A.

Be more liberal in terms of limit setting and tolerating
hostility in order to facilitate honest communication

B.

Ensure the patient that under no circumstances will anything
said be repeated to the parents

C.

Allow silences to last as long as necessary until the
patient is inclined to offer any verbal input

D.

Communicate to the patient that his or her perspective is
valued and will not be judged or critiqued

Question 26

The PMHNP is preparing an educational program for primary
care providers about child abuse awareness. The goal of the program is to
increase the understanding of primary care providers regarding risk factors for
child abuse so that at-risk families may be identified and primary preventive
strategies implemented before any harm occurs to children. The program
emphasizes risk factors for child maltreatment to include all of the following
except:

A.

Single-parent families

B.

Low parental education

C.

Parental substance abuse

D.

Firstborn child in the family

Question 27

A variety of questionnaires, scales, guided-interview tools,
and other standardized instruments are available to aid with various aspects of
assessment. The majority are intended only to be used as an aid to information
gathering and not to make a diagnosis. Which of the following tools requires
training to administer and can be used to determine diagnoses?

A.

Child and Adolescent Psychiatric Assessment (CAPA)

B.

Brief Impairment Scale

C.

Pictorial Instrument for Children and Adolescents
(PICA-III-R)

D.

Achenbach Child Behavior Checklist

Question 28

Brian is a 13-year-old boy who presents for care. He was
initially brought in by his mother after a family friend suggested mental
health evaluation. Brian has been suffering with a variety physical symptoms
for the past 8 months, ever since school started. He has missed so much school
that he is in danger of not advancing to the eighth grade. He persistently
complains of headache, stomachache, nausea, and dizziness. He has even vomited
on more than one occasion, so his mother knows something is ?really wrong.? The
pediatrician has been unable to identify a cause of symptoms or offer any
relief. During his interview, the PMHNP learns that this is Brian’s first year
in middle school. There are hundreds of students, and it is much larger than
the intimate elementary school Brian attended from kindergarten through sixth
grade. Brian is certain that all the students are making fun of him; he does
not even go to the lunchroom to eat. He has stopped socializing with his small
group of friends from elementary school because they have made friends among
the other seventh graders. Brian says he wants to have friends, but he just
gets nervous and he is sure they will all make fun of him. Brian enjoys
?hanging out? with his cousins, and they spent the week of spring break playing
at his house. But, when it was time to go back to school, Brian was so nauseous
he could not attend. Initial treatment for Brian should include:

A.

Psychiatric hospitalization

B.

Cognitive behavioral therapy

C.

Fluvoxamine (Luvox) 50 mg daily

D.

Family interventions

Question 29

When evaluating treatment strategies for a 14-year-old
patient with obsessive-compulsive disorder (OCD), the PMHNP considers that
evidence-based data from the Pediatric OCD Treatment Study (POTS) suggests that
best outcomes are achieved with cognitive behavioral therapy (CBT) and:

A.

Clomipramine (Anafranil)

B.

Sertraline (Zoloft)

C.

Aripiprazole (Abilify)

D.

Lithium (Eskalith)

Question 30

Susan is a 10-year-old girl who has been referred by her
pediatrician for mental health evaluation due to a persistent collection of
somatic symptoms for which there is no apparent organic cause. For the last 2
months Susan has been increasingly distraught at the prospect of leaving home.
This has become very apparent since the start of the school year. She often
develops stomachaches and headaches when it is time to go to school. Lately she
does not want to go to bed unless her mother remains upstairs. The PMHNP
considers a diagnosis of:

A.

Separation anxiety disorder

B.

Social anxiety disorder

C.

Generalized anxiety disorder

D.

Social phobia disorder

Explain why Treatment of abused children is multimodal and long term. Explain why Treatment of abused children is multimodal and long term.Explain why Treatment of abused children is multimodal and long term.Explain why Treatment of abused children is multimodal and long term.

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