NURS 6660N-8 Treatment of early-onset schizophrenia can be challenging due to the paucity of evidence-based support for various pharmacotherapeutics and nonpharmacologic interventions

NURS 6660N-8 Treatment of early-onset schizophrenia can be challenging due to the paucity of evidence-based support for various pharmacotherapeutics and nonpharmacologic interventions

NURS 6660N-8 Treatment of early-onset schizophrenia can be challenging due to the paucity of evidence-based support for various pharmacotherapeutics and nonpharmacologic interventions

NURS 6660N-8 Week 11 Final Exam

1. Question: Conventional antipsychotics are not first-line interventions in early-onset schizophrenia due to the risk of dystonic reactions. However, when children are not responsive to first- line therapy with atypical antipsychotics, which of the following is the most appropriate conventional choice?
2. Question: The therapeutic outcomes for children with disorders of written expression are most favorable when they are … by:
3. Question: Linda is a 5-year-old girl who has persistent pica; she was finally … for care when her kindergarten teacher became … by her eating of potentially toxic nonfood substances. Linda’s mother admits during the history that Linda has been doing this for years, but thought it was not a big deal since Linda didn’t eat anything dangerous. Linda’s mother must work two jobs and essentially did not bother to pursue Linda’s unusual symptom because it didn’t seem unsafe. While discussing management strategies with Linda’s mother, the PMHNP counsels that the most rapidly successful treatment strategy appears to be:
4. Question: Rumination is a feeding disorder most commonly seen in infants, but it can occur at any point in the lifespan. Characteristic findings in infants include:
5. Question: 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 something was different as far back as she can remember. She always … to wear her mother’s clothes and makeup and play with other girls. Katelyn … dressing and openly identifying as a girl when she was 13 years old, and her parents are trying to be supportive 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 relationship. The PMHNP explains that Katelyn:
6. Question: All the following are true with respect to making a diagnosis of major depressive disorder in children except:
7. Question: Donna is a 16-year-old transgender female who has been through extensive individual and family counseling and is ready to start hormone therapy with estrogen, progesterone, and testosterone-blocking agents. When counseling her specifically about the risks, benefits, and … monitoring of hormonal therapy, the PMHNP advises Donna that:
8. Question: The leading cause of death in youths living in juvenile residential facilities is:
9. Question: 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 literature review of this article should include all the following except:
10. Question: Tiana is a 10-year-old girl who is being … for evaluation because her school performance is appreciably below what is expected at her age. Historically she has been a very happy child, likes school, and looks forward to going. However, over the last several months her teacher reports that she is much slower than her peers in reading, and she appears to be upset and withdrawn when asked to read in class. The PMHNP would expect additional report from the teacher to include all the following except:
11. Question: Which of the following statements best … the treatment course and progression of bulimia nervosa?
12. Question: Kelly is a 14-year-old female who has finally been … for management of anorexia nervosa. She was … almost 1 year ago with the food-restricting subtype, but attempts to get her into psychiatric care were unsuccessful. She continues to be resistant but her caloric intake is now < 400 daily and she finally appears to be unable to sustain the supraphysiologic levels of exercise that she has maintained to try and “keep her weight down.” She is 5’2” tall and weighs 82 lbs., which is approximately 75% of ideal body weight for her height. Her vital signs are stable and surprisingly there are no profound laboratory or ECG abnormalities. When counseling Kelly and her parents about the recommended course of treatment, the PMHNP advises that Kelly will require:
13. Question: In which demographic is depression twice as prevalent in girls as … to boys?
14. Question: Debbie is a 10-year-old female who has been … to remediation therapy for her reading disorder. While designing her treatment program, the PMHNP knows that the most current strategies are characterized by:
15. Question: Which of the following symptom clusters is most likely in a 16-year-old male with major depressive disorder?
16. Question: The etiology of childhood depression is multifactorial and may include biological factors. Which of the following is a true statement with respect to hormonal studies in … children?
17. Question: Jared is a 6-year-old boy who comes to the PMHNP for an evaluation with his father. The father reports that he is … about Jared because he has had problems fitting in at school ever since he started kindergarten. He does not have any friends at school and does not seem to know how to play with others. Dad reports that Jared has never been “very talkative” and sometimes switches from one topic to another without any reason. When considering early-onset schizophrenia, the PMHNP recognizes that which of the
18. Question: Learning disorders affect at least 5% of all school-aged children in the United States. Since 1975, Public Law 94-142 mandates that all states provide free, appropriate services to all children. Among the various types of learning disorders, the PMHNP knows that the overwhelming majority are:
19. Question: 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:
20. Question: 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 infants. If an infant is either … by the provider or reported by the parent to frequently suck the tongue rhythmically or appear to strain with his or her back … and then swallow, the examiner should consider the possibility of:
21. Question: Which of the following is a true statement with respect to avoidant/restrictive food intake disorder?
22. Question: Regarding pediatric suicide, which of the following is a true statement?
23. Question: 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:
24. Question: The PMHNP is treating Pam, a 13-year-old female, for moderate-to-severe major depressive disorder. In addition to cognitive behavioral therapy, the PMHNP discusses with the patient and her father the plan to begin sertraline, 50 mg daily, then titrate the dose up when tolerance is established. Pam’s father has … this medication and is … because he read about the risk of increased suicidal ideation. The most appropriate response is to tell Pam’s father that:
25. Question: 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 clozapine, outcomes were … 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?
26. Question: While counseling the parents of Joshua, a 9-year-old patient with developmental coordination disorder, the PMHNP … that the treatment will include:
27. Question: The literature indicates that boys whose fathers … before the age of 13 are at a greater risk for the development of depression as … to controls. This is consistent with which general theory of depression etiology?
28. Question: Standardized instructional programs … in the management of reading disorders include all the following except:
29. Question: The PMHNP suspects that Wesley, an 8-year-old male, has a reading disorder. In kindergarten his teacher … some suspicion for a disorder, but throughout first grade and now into second grade, he is clearly functioning below … levels.. He becomes increasingly anxious when … to read in school. Which aspect of Wesley’s history would support the risk for this diagnosis?
30. Question: When counseling the parents of an intersex neonate, the PMHNP recognizes that the current standard of care is to counsel toward:
31. Question: Jessica is a 26-month-old female who is being … because she will not eat. Her parents report that she just flat out will not eat her meals. Her mother says that she has … all the pediatrician’s suggestions: she has … any snacks or drinks between meals, and she has … a variety of foods, including those that Jessica … to enjoy previously. Jessica is not sick; has no problems with vomiting or elimination abnormalities. Jessica’s parent say that her pediatrician is not …, but they are not comfortable with what appears to be an almost complete absence of food intake. While considering a diagnosis of avoidant food intake disorder the PMHNP knows that any of the following would fulfill the diagnostic criteria except:
32. Question: Rose is a 13-year-old girl who is being … as part of a family assessment; the primary patient is Rose’s 8-year-old brother who is demonstrating behavior of concern and is having a court-… evaluation. During the family assessment, it becomes apparent that Rose’s mother is very … that Rose is a tomboy. The mother, who is very elegant, is distressed by Rose’s persistent “tomboy” behavior and worries that Rose might become a lesbian, which would be “unacceptable” to the family. More … evaluation of Rose reveals that she is experiencing some sexual reflection. She excels at sports and has always … rough and tumble play, but she doesn’t see anything wrong with that. She thinks she is sexually … to one of her female teachers, and sometimes fantasizes about her. Rose just began menstruating 3 months ago, and while she has had a boyfriend at school, she is not sexually active in any way; they have kissed a few times, and she likes it, but she has no plans to take it any further. Otherwise Rose seems well …, worries about her brother, and dismisses her mother’s concerns as “silly.” Which of the following statements best characterizes Rose?
33. Question: Caylee is a 5-year-old girl who is … for evaluation by child protective services. She was recently … from her biological family and … in foster care as her home environment was … unsafe due to conditions of extreme neglect. Her foster mother reports that Caylee is very quiet and withdrawn and always appears sad and … in her surroundings; however, she becomes very irritable when anything unexpected or unplanned occurs. The foster mother became very concerned when it appeared that Caylee was hallucinating. The PMHNP considers that:
34. Question: Stevenson is a 21-year-old woman who brings her 3-week-old infant to the PMHNP for an “emergency” evaluation. Ms. Stevenson has a 2-year-old who was … with rumination disorder when he was 10 months old and had to … for tube feedings while the family … treatment. Ms. Stevenson is worried now because her new baby vomits every time he eats; she is afraid he has the same thing. The PMHNP counsels Ms. Stevenson that:
35. Question: Confidentiality is a complex topic in the world of child and adolescent psychiatry. The last 40 to 50 years have been … 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?
36. Question: Which of the following is a true statement with respect to developmental coordination disorder?
37. Question: The PMHNP is preparing a presentation for a conference of pediatric primary care providers. The topic of the presentation is early identification and referral of developmental coordination disorder. When outlining high-risk populations, the PMHNP discusses that statistically there is a higher incidence of occurrence in children with all of the following except:
38. Question: A 14-year-old boy was … to care by his parents because of progressive social withdrawal. Upon completion of the patient interview, mental status exam, and family assessment, review of all information reveals that for the past 15 months Bruce has been progressively “moody.” His parents say that he has become so irritable that his little brother and sister are afraid to talk to him anymore. Additionally, he has become socially withdrawn, now not even wanting to go to school. Bruce says he is … all the time and just doesn’t feel like doing anything. He often does not complete homework assignments. When considering a diagnosis of dysthymic disorder, the PMHNP knows that which other history finding must be present?
39. Question: Debi is a 15-year-old girl who is currently being … for depression. Her parents have been very proactive and … in her care, and Debi has … remission 2 months after beginning treatment with a combination of pharmacotherapy and cognitive behavioral therapy. While counseling Debi’s parents about important issues in management, the PMHNP advises that:
40. Question: The current scholarly consensus is that the etiology of bulimia nervosa is multifactorial to include biological, sociocultural, family, cognitive-behavioral, and psychodynamic factors. When considering the etiology of bulimia nervosa, the PMHNP understands that:
41. Question: Henderson is a 24-year-old mother of 4 children under the age off 5. She has … a trust relationship with the PMNHP after successful evaluation and management of ADHD in her oldest child. She now brings in her 3-year-old for an evaluation because she keeps eating things she finds within reach – paper, dirt, and one day, the mother found this child eating from the cat litter box. The mother says the child is up to date on her vaccines but she has not … this problem to the pediatrician. The PMHNP knows that immediate assessment must include:
42. Question: There is a high incidence of overlap among children with bipolar disorder, attention deficit hyperactivity disorder, conduct disorder, and anxiety disorders. Which of the following manic symptoms of bipolar disorder are most closely … to conduct disorder?
43. Question: Bipolar I disorder is being … with increasing frequency in prepubertal children. Which of the following is a true statement with respect to this trend?
44. Question: Marion is a 17-year-old female who has been … by her high school guidance counselor for evaluation. The counselor is … that Marion has an eating disorder because she has seen her in the bathroom on several occasions vomiting, but there is no other indicator of illness like fever or missing school days. When considering the diagnosis of anorexia nervosa, the PMHNP knows that all of the following must be present except:
45. Question: Susan is a 12-year-old girl who is … for psychiatric evaluation because she is having social problems at school. She is always … last for teams in physical education, and she is becoming exceedingly … about the lack of social interaction at school. A … history reveals that Susan has always had … developmental milestones, including … sitting without support and transferring objects hand to hand. She did not walk until she was 20 months old, and for years afterward had persistent issues with falling. Now, at age 12, she is having trouble with her handwriting. The PMHNP considers which of the following diagnoses as most likely?
46. Question: Maria is an 11-year-old girl who has been … with early-onset schizophrenia. In writing up her case report for publication, the PMHNP makes it a point to highlight which of the following historical features that are often seen in schizophrenia of middle childhood?
47. Question: When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?
48. Question: 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 school work. 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:
49. Question: Christine is a 9-year-old female who presents for care after having been … in the local foster care system. She has been in and out of foster care for the last 4 years after her parents were … in an automobile accident. Christine has been … in a variety of homes and residential care facilities. The PMHNP recognizes that Christine is at high risk for:
50. Question: Ramon is a 12-year-old male who was … on fluoxetine, 40 mg daily, for major depressive disorder 6 weeks ago. At his 2-week follow-up he was feeling well with no adverse drug effects, and his dose was … from 20 to 40 mg. Today he presents for a routine follow-up visit. He reports that he has been “all wound up” and is frequently agitated. He cannot sleep well and has trouble focusing at school. His friends say that he gets upset quickly, and they are starting to avoid him. The most appropriate approach is to:
51. Question: While not currently … for the treatment of early-onset bipolar disorder, which of the following medications has … utility in clinical trials without any … weight change, rash, or other adverse events?
52. Question: In the juvenile justice system, the difference between delinquent acts and status offenses is:
53. Question: Cameron is a 7-year-old boy who has been … with ADHD and … on psychostimulants. Two months later there has been no meaningful improvement of symptoms, and he is … from primary care to a PMHNP. While reviewing his records, the PMHNP notes that Cameron has been living with his aunt and uncle and their four children since the death of his mother 6 months ago. Cameron, who reportedly was always a happy and well-… only child, … symptoms shortly after these major life changes. His symptoms were … primarily by temper tantrums and an inability to sit still. He is not functioning well in school and is having repeated stomachaches and headaches. The PMHNP considers that the most appropriate action
54. Question: The PMHNP has been … in custody evaluations and is preparing to perform his first evaluation as a guardian ad litem. The case involves a 6-year-old boy and his 4-year-old sister. The parents are very angry and not able to talk or come to any agreements at all. Both parents want full custody and support from the other parent, both of whom are working professionals. After interviewing each party alone and then conducting a family interview, the PMHNP reviews all records made available, including the legal filings and petitions. There are no allegations of abuse or neglect or unsuitability from either parent; they just each want full custody. In addition to considering the best interests of the children, the PMHNP knows that the elements … by the court will include all the following except the:
55. Question: Justin is a 12-year-old male who was recently … with schizophrenia. He was quickly … into a highly … assessment and treatment program and began pharmacotherapy and cognitive behavioral therapy. His parents have had a difficult time with the diagnosis as Justin has always been very healthy, a good school performer, and has never had any developmental concerns or delays. However, they are very supportive and … to his recovery. Justin has been on an atypical antipsychotic for 1 month with no intolerable adverse effects. When counseling Justin’s parents about the prognosis, the PMHNP advises the parents that which of the following is more … with good outcomes in patients like Justin?
56. Question: There are several physiologic abnormalities that may result in ambiguous genitalia and/or an unclear sense of gender identity leading to gender dysphoria. When an adolescent female is found to have cryptorchid testes, this indicates a condition known as:
57. Question: Ryan is a 6-year-old male who is being … because his pediatrician is … that he demonstrates a … inability to perform the daily motor skills consistent with what is … at his age. At the age of 3 he was assessed due to delay in developmental milestones and was found to have an IQ of 68, consistent with mild mental retardation. When interpreting his motor coordination today, the PMHNP considers that:
58. Question: 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 … for 3 years and want to have children. Debbie is … 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 … about the disease. Debbie is an only child and her father had schizophrenia that was not well controlled. He … suicide when she was 15 years old. Debbie takes olanzapine and feels well overall. She has a part-time job, functions well, but is … about the genetic nature of her disease. Counseling for Bruce and Debbie includes which of the following pieces of information?
59. Question: The American Adoption Congress represents the … interests of the adoption triad, a phrase … to represent:
60. Question: Roshan is a fourth grader who is being … for poor scholastic performance in mathematics. He has always been a happy, healthy child, has … with friends at school, and presents no behavioral concerns at home. However, his math performance has always been below the average for his grade, and now he is performing so far below his peers that he is really beginning to be upset about it. While being … for a learning disorder, the PMHNP appreciates that Roshan has had a … deficit in his ability to recognize and understand symbols and order clusters of numbers. This suggests a deficit in:
61. Question: The PMHNP is having a family meeting with 8-year-old Hunter and his father and stepmother to discuss the results of his mathematics assessment. Analysis of his performance on the KeyMath Diagnostic Arithmetic Test reveals a performance … below what is … for his age. Hunter’s mother feels certain that his poor performance is a result of poor education; apparently Hunter’s mother was homeschooling him, but subsequently she was found to be so neglectful of all of his needs that his father and stepmother were given full custody. When discussing the course and prognosis for Hunter’s mathematics disorder, the PMHNP advises that:
62. Question: When considering a diagnosis of developmental coordination disorder, the PMHNP knows that the diagnosis may … with:
63. Question: Margaret is a 14-year-old girl being seen in follow-up for major depressive disorder. She has been on a therapeutic dose of a selective serotonin reuptake inhibitor (SSRI) for 3 months and has still … to achieve remission. Consistent with the Texas Children’s Medication Algorithm Project (TMAP), the next action should be to:
64. Question: Benjamin is a 4-year-old male who is being … 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 … with schizophrenia. Today she reports that Benjamin has episodes during which he appears to be hallucinating. Sometimes he seems to see things that aren’t 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 observation of Benjamin during play. When considering a diagnosis of early-onset schizophrenia, the PMHNP considers all of the following except:
65. Question: The PMHNP is working with the parents of a 13-month-old male who is … with avoidant/restrictive food intake disorder. The toddler will eat, but he seems to tire both physically and emotionally very quickly and is easily …, he will not return to the meal. His weight trajectory has … and he has gone from a weight of 60 percentile for age/height to 10 percentile for age/height. As part of the transactional plan of care, the parents will … to:
66. Question: Children with gender dysphoria typically have higher rates of all the following except:
67. Question: Andrew is a 14-year-old male who is being … for bipolar I disorder. He was … on lithium 6 weeks ago and has … a serum level of 1.1 mEq/L according to his most recent blood work. Andrew says he doesn’t 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 … 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?
68. Question: An astute pediatrician has … Kyle, a 5-month-old infant, for evaluation of rumination disorder. His mother was … 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:
69. Question: The difference between hormonal management of transgender adolescents from adults is that which of the following has no role in adult management?
70. Question: Eileen is a 23-month-old girl who is being … for autism spectrum disorder because her pediatrician is … 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 may 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?
71. Question: Rose is a 12-year-old female who is being … for declining school performance and an increasing tendency to try to avoid going to school. Historically she has been an average student, although she has particularly … with writing exercises and has actually … assignments this year. She consistently ignores rules of grammar, and her teacher says that her writing submissions look as if they were written by a much younger child. The PMHNP knows that the initial evaluation of Rose must include all the following except:
72. Question: Kelly is a 13-year-old female who is being … at the recommendation of her seventh-grade teacher. This is her first year in junior high and her teacher is … over what appears to … social isolation. She does not appear to have any close friends or social contacts. She eats lunch with the girl who lives next door to her, but even that is … more by the other child. Her teacher also … that Kelly seems to have certain unusual preoccupations, such a preoccupation with religions despite the fact that her family has never been religious. During the examination, Kelly clearly demonstrates some odd behavior. When talking about her family, she does not express any emotion. She doesn’t laugh at anything and appears withdrawn, yet she will answer questions … of her. The PMHNP, after completing his evaluation, considers a diagnosis of schizotypal disorder because review of Kelly’s assessment reveals:
73. Question: The PMHNP is developing a brief informational pamphlet on gender dysphoria to distribute at a local mental health awareness event for the general public. The “basic facts” section of the pamphlet correctly states that:
74. Question: Early-onset schizophrenia is quite rare as … to adolescent and adult onset. Certain features are unique to early-onset schizophrenia and include all the following except:
75. Question: All of the following are … etiologies of pica except:
76. Question: Taryn is a 14-year-old female who is being … as a condition to return to the private school in which she has been … since fifth grade. She has an ongoing inability to focus in school, and her mood … ranges from “one extreme to the other.” Per her mother, she is either overly … about something and almost … in her approach, or she is … and irritable and doesn’t want to leave her bedroom. She was … several different times in childhood for ADHD, and even took medication once, but it didn’t help. In considering a diagnosis of cyclothymic disorder, the PMHNP considers that: NURS 6660N-8 Treatment of early-onset schizophrenia can be challenging due to the paucity of evidence-based support for various pharmacotherapeutics and nonpharmacologic interventions NURS 6660N-8 Treatment of early-onset schizophrenia can be challenging due to the paucity of evidence-based support for various pharmacotherapeutics and nonpharmacologic interventions

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