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NR 606 Exam Questions with Correct Solved Solutions
1. Children in the pre-operational stage think and use what to represent
objects?: symbolically, use words or pictures
2. in which stage of piaget's model does thinking become more logical and organized
about events and children can reason inductively: concrete opera- tional (age 7-11)
3. which stage is defined by the ability to reason abstractly and consider hypo- thetical
problems as well as moral, ethical, social, and political issues?: formal operations (12+)
4. Can a parent access information if the provider has concerns about parental abuse or
neglect?: the provider can decide whether or not to treat the parent as a personal representative
5. If the parent is not the child's personal representative under HIPPA, do they have
access to the health records?: depending on state laws- if the state has a law against it then no, if the state does permit the provider to share health information then the provider is able to
6. A challenge to prescribing psychoactive medications in the perinatal period is: the
paucity of evidence regarding the true risks for the pregnant client and developing fetus
7. If a pregnant client is stable on their current medication regimen what should the
PMHNP keep in mind: keep them on current med rather than switching
8. When should the PMHNP refer the patient to a perinatal psychiatrist: when the
patient is on a high-risk medication for pregnancy
9. most common adverse effect associated with SSRIs and SNRIs: neonatal
withdrawal syndrome
10. symptoms of neonatal withdrawal syndrome: Symptoms include tremors, high-
pitched crying, and disturbed sleep
11. increase the risk of atrial septal defects.: paroextine
12. symptoms of newborn toxicity r/t benzodiazepine use during pregnancy: -
Symptoms include sedation, floppy muscle tone, and potential breathing issues at birth
13. bipolar medications that are considered teratogenic and should be avoid- ed during
pregnancy.: valproic acid and carbamazepine
14. Atypical antipsychotics that increase risk of gestational diabetes and large for
gestational age infants: olanzapine and quetiapine
15. has also been found to increase the risk of musculoskeletal malformations in
infants: olanzapine
16. the most used antipsychotics during pregnancy: risperidone and quetiapine
17. medications that are safe for breast feeding: SSRIs, benzos, valproic acid,
including: premature rupture of membranes, placental abruption, preterm birth, low birth weight, and small for gestational age deliveries, as well as long-term effects in children and adolescents including lower short-term memory, child and adolescent delinquent behavior, earlier age of sexual activity, and substance use
25. complications of opioid use during the perinatal period: eclampsia, heart attack or
heart failure, and sepsis. Infants experience significant adverse effects, including neonatal abstinence syndrome, third trimester bleeding and mortality, postnatal growth deficiency, microcephaly, neurobehavioral problems, and sudden infant death syndrome
26. includes policies, regulations, or laws that intentionally or unintentionally lead to
discrimination: structural stigma
27. an example of structural stigma: MAT
28. encompasses the attitudes, beliefs, and behaviors of groups or individuals which
form a stereotype that creates an emotional reaction or prejudice and results in discrimination.: public stigma
29. refers to the shame individuals internalize about negative stereotypes, may prevent
themselves from seeking help: self-stigma
30. only validated behavioral health screening instrument designed specif- ically for
pregnant women. It screens for alcohol, tobacco, marijuana, and illicit drug use. In addition, validated screening questions for depression and domestic violence can be included.: The 4Ps Plus
31. validated for use with adults to generate a risk level for each substance class. It
can be self-administered or conducted via clinician interview and combines screening and brief assessment of past 90-day problematic use into one tool: Tobacco, Alcohol, Prescription medication, and other Substance Use (TAPS) Tool
32. assess substance use disorder risks among adolescents 12-17 years old.-
: NIDAMED's Screening Tools for Adolescent Substance Use
33. when is inpatient treatment recommended for alcohol use disorder in pregnant
women?: for clients at risk for moderate, severe, or complicated alcohol withdrawal as indicated by a score of more than 10 on the CIWA
34. meds for tobacco use disorder that are safe in pregnancy: nicotine replace- ment
therapy (NRT), bupropion, or a combination
35. why use IR over ER in pregnancy: an help minimize infant exposure during
pregnancy and breastfeeding.
36. OUD meds that are safe during pregnancy: methadone and buprenorphine
Pre-term birth Longer stay in the NICU Excessive crying Impaired parent-child interactions Social-emotional, cognitive, language, motor, and adaptive behavior development Adverse Childhood Experience
42. Risk Factors for MMHDs: Smoking
Lack of social support Poor relationship quality Pregnancy complications Personal or family history of depression History of physical or sexual abuse Unintended pregnancy Life stress Chronic physical conditions Prior pregnancy with fetal/infant loss History of mental illness
43. pathophysiology of the baby blues: The abrupt change in hormones that occurs
when the placenta is delivered may contribute to the development of symp- toms and may be exacerbated by fatigue, pain, overstimulation, lack of support, or insecurity
44. baby blues symptoms: Poor concentration
Moody Feeling sad Fatigue Easily angered Insomnia Anxiety Crying without reason Poor concentration
45. baby blues causes: Drastic hormonal changes
Fatigue after giving birth and breastfeeding Sudden changes in routine caring for baby Lack of support from partner or family Transition to being a mother
46. the most common maternal mood disorder: depression
47. when can the specifier "with peripartum onset" be applied: can be applied to
depressive disorders if the onset of mood symptoms occurs during pregnancy or in the
54. First line therapy for perinatal PTSD: first line= psychotherapy SSRIs
may be used for comorbid depression
55. screening tool used for bipolar disorder: MDQ
56. Screening tool used for depression: PHQ- 9
57. tool used to monitor symptoms of bipolar disorder after diagnosis: young mania
rating scale
58. tool used to assess clients who present with symptoms of psychosis: brief
psychiatric rating scale
59. how can maternal depression and anxiety can impact fetal development in utero:
increase the risk for preterm birth and low birth weight, and lead to an inse- cure attachment between the mother and infant as well as suboptimal breastfeeding practices
60. Diagnostic criteria for GAD in children and teens: only one physical or cognitive
symptom is required for diagnosis whereas three symptoms are required for adult diagnosis
61. Screen for Child Anxiety Related Disorders (SCARED) tool Child Version-
: enables providers to screen for several types of anxiety disorders, including gen- eralized anxiety, panic disorder, separation anxiety, and social anxiety.
62. A total score of or more points on the SCARED scale indicates a
potential anxiety disorder: 25
63. To meet diagnostic criteria for OCD, the obsessions and compulsions must be:
time-consuming (>1 hour per day) and disrupt normal routines, functioning, or relationships.
64. PANDAS: pediatric autoimmune neuropsychiatric disorders associated with
streptococcal infections
65. lab test to detect PANDAS: Cunningham panel
66. First-line treatment for mild to moderate OCD: CBT which includes exposure and
response prevention
67. If symptoms persist after two or more trials of an SSRI or clomipramine and failure
to respond to CBT, treatment may be augmented with: an atypical antispcyhotic
68. Body dysmorphic disorder (BDD): type of obsessive-compulsive disorder in which
an individual becomes preoccupied with one or more perceived flaws in physical appearance that are not visible or appear slight to others
69. screening tools for use with clients who may have BDD: Body Dysmorphic Disorder
Questionnaire (BDDQ) The BDD Yale-Brown Obsessive Compulsive Scale for Adolescents
78. an evidence-based treatment that can help clients manage life with a mood
disorder by promoting regularity in daily routines: interpersonal and social rhythm therapy
79. Early intervention for youth at genetic risk for developing BPT: IRPT with Data-
Informed Referral (IPSRT+DIR) before symptoms manifest shows promise in helping youth establish more regular sleep-wake cycles which may help decrease mood fluctuations
80. the preferred drug for adolescents with bipolar disorder with mixed fea- tures:
Divalproex
81. The hallmark clinical feature of DMDD: chronic, persistent irritability and anger.
82. DSM5 criteria of DMDD: outbursts of temper >3 times per week, chronically irritable
or anger that is observable to others, symptoms present >12 months, symptoms present in at least 2 out of 3 settings (home, school, peers), ages 6-18, onset before age 10
83. when can DMDD not be diagnosed: if bipolar, intermittent explosive disorder, or
oppositional defiant disorder are present
84. screening tool for DMDD: KSADS-PL
85. therapies for DMDD: CBT= first line
computer-based interpretation bias training (IBT) to help children and adolescents more accurately interpret others' emotions
86. medications for DMDD: stimulant medications- decrease irritability
Antidepressants- irritability and other mood problems Atypical antipsychotics- control severe outbursts of temper/ aggression
87. which medication requires up to 30% increased dosage for clients who smoke
concurrently: olanzapine
88. actors associated with an increased likelihood of developing ASD: having a sibling
with ASD, having older parents, having certain genetic conditions such as Fragile X syndrome or Down syndrome, or having a very low birth weight
89. DSM-5 criteria for ASD includes: ersistent deficits in communication and social
interaction across multiple contexts and restrictive, repetitive patterns of behavior, interests, or activities. Symptoms must appear early in development and can cause clinically significant impairment in functioning.
90. Early signs of ASD include: avoiding eye contact
showing little interest in peers or caretakers limited language abilities frustration with minor changes in routine
and imitation skills and takes 20 minutes to administer.: - screening tool for autism in toddlers and young children
97. Enhances new skill development through rewards-based motivational sys- tems:
applied behavior analysis therapy
98. Provides educational resources, coping strategies, and communication skills for
parents of children with ASD: parent training
99. Improves social skills including conversation, being a good sport, and
managing teasing from other children: social skills training
100. may be used for clients with ASD who have hyperactivity, impulsive
behaviors, and sleep problems.: guanfacine and clonidine
101. may be used for clients with ASD who have aggressive behaviors,
tantrums, sleep disorders, or motor tics.: second gen antipsychotics
102. may be used for clients with ASD who have repetitive behaviors and
aggression.: Tricyclic antidepressants (clompiramine)
103. may be used for clients with ASD who have hyperactivity, short attention spans,
and impulsive behaviors.: stimulants
104. rare neurodevelopmental disorder that is typically caused by a mutation in the
methyl CpG binding protein and is characterized by normal growth and development
early in life followed by impaired growth and development later in life: Rett syndrome
105. what usually happens when boys develop Rett syndrome?: severe prob- lems
when they are born and die shortly after birth
106. one of the most disabling aspects of Rett syndrome, interfering with all body
movements, including eye gaze and speech: Apraxia
107. TS often occurs comorbidly with other psychiatric conditions such as: -
ADHD, OCD, learning difficulties, depression
108. four diagnostic criteria are required for TS including:: he presence of multiple
motor tics and one or more vocal tics, which may not occur concurrently tics may wax and wane in frequency but have persisted for more than 1 year since the first tic onset 9 tic onset is before 18 years of age tics are not caused by the use of a substance or other medical conditions
109. scaling for Tics: 0= none
10= minimal 20=mild 30=moderate 40=marked 50=severe
