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NURS 6660 Final Exam Practice: Psychiatric
Mental Health Nurse Practitioner Role I:
Child and Adolescent
Instructions
This practice exam consists of 75 multiple-choice questions designed to prepare you for the NURS 6660 Final Exam at Walden University. The questions cover key topics in child and adolescent psychiatric mental health, including diagnostic criteria, psychopharmacology, ethical considerations, and therapeutic interventions. Each question includes four answer options, listed on separate lines, the correct answer, and a rationale explaining why the answer is correct. Use this to study and reinforce your understanding of the course material
Question 4
Andrew, a 14-year-old male with bipolar I disorder, started lithium 6 weeks ago with a serum level of 1.1 mEq/L. He reports no change, but his parents and teachers note improved mood stability. The PMHNP should: a. Increase the lithium dose b. Discontinue lithium c. Continue the current dose d. Switch to valproate Correct Answer : c Rationale : A serum lithium level of 1.1 mEq/L is therapeutic, and improvements noted by parents and teachers suggest efficacy. Continuing the current dose is appropriate.
Question 5
Regarding pediatric suicide, which statement is true? a. Suicide rarely occurs in children who have not reached puberty b. Cognitive immaturity is significantly correlated with completed suicide c. 75% of suicidal children communicate intent within 24 hours d. Suicidal ideation has decreased in adolescents over the last 15 years Correct Answer : a Rationale : Suicide is very rare in prepubertal children, with rates increasing significantly during adolescence.
Question 6
The PMHNP is counseling the father of Pam, a 13-year-old with depression, who is concerned about sertraline’s suicide risk. The most appropriate response is: a. Sertraline is the only drug indicated for adolescents b. Treatment with sertraline and CBT reduces suicide risk c. Switch to another drug class to avoid risk d. Sertraline carries no suicide risk Correct Answer : b Rationale : Research shows that combining sertraline with cognitive behavioral therapy (CBT) reduces suicide risk in adolescents with depression.
Question 7
Confidentiality in child and adolescent psychiatry is complex. Which statement is not true? a. Consent for disclosure is not needed in cases of child abuse b. Children 12 and older can consent to disclosure per APA guidelines c. Parents always have full access to a minor’s psychiatric records d. State laws vary on confidentiality for adolescents Correct Answer : c Rationale : Parents do not always have full access to a minor’s psychiatric records, as laws vary by state and adolescents may have certain privacy rights.
Question 8
Conventional antipsychotics are not first-line for early-onset schizophrenia due to: a. Risk of dystonic reactions b. Lack of efficacy c. High cost d. Need for daily dosing Correct Answer : a Rationale : Conventional antipsychotics have a higher risk of dystonic reactions, making atypical antipsychotics preferred for early-onset schizophrenia.
Question 9
Rumination, a feeding disorder seen in infants, is characterized by: a. Excessive weight gain b. Voluntary regurgitation and re-chewing c. Refusal to eat solid foods d. Allergic reactions to formula Correct Answer : b Rationale : Rumination disorder involves voluntary regurgitation and re-chewing of food, often leading to nutritional deficiencies.
Question 10
Kelly, a 14-year-old with anorexia nervosa (food-restricting subtype), weighs 82 lbs (75% of ideal body weight). The PMHNP advises that treatment requires: a. Intensive dynamic psychotherapy alone b. Hospitalization and nutritional rehabilitation
Correct Answer : c Rationale : Sertraline is an SSRI used for depression or anxiety, not a first-line treatment for bipolar disorder, which requires mood stabilizers like lithium.
Question 14
A 16-year-old female presents feeling like a female despite being born with male genitalia. This is consistent with: a. Gender dysphoria b. Body dysmorphic disorder c. Conversion disorder d. Schizophrenia Correct Answer : a Rationale : Gender dysphoria involves a persistent identification with a gender different from one’s assigned sex at birth.
Question 15
The mean length of a major depressive episode in adolescents is approximately: a. 2 months b. 4 months c. 8 months d. 12 months Correct Answer : c Rationale : The average duration of a major depressive episode in adolescents is about 8 months, though it varies by individual.
Question 16
Avoidant/restrictive food intake disorder (ARFID) does not include: a. Significant weight loss b. Nutritional deficiency c. An irritable, apathetic, or anxious affect d. Food avoidance due to sensory issues Correct Answer : c Rationale : ARFID involves food avoidance leading to weight loss or nutritional deficiency, but affect is not a diagnostic criterion.
Question 17
Rose, a 13-year-old, is evaluated during a family assessment. Her brother is the primary patient. Rose shows signs of: a. Bipolar disorder b. Adjustment disorder c. Schizophrenia d. Autism spectrum disorder Correct Answer : b Rationale : Rose’s symptoms during a family assessment are likely related to adjustment issues due to her brother’s behavior, a common finding in family evaluations.
Question 18
The PMHNP knows that 20–40% of adolescents with major depressive disorder may develop: a. Schizophrenia b. Bipolar I disorder c. Generalized anxiety disorder d. Eating disorders Correct Answer : b Rationale : 20–40% of adolescents with major depressive disorder may develop bipolar I disorder within 5 years.
Question 19
Which laboratory tests are required for ongoing monitoring of lithium in an adolescent? a. Complete blood count, thyroid function, serum calcium b. Liver function tests, complete blood count, ECG c. White blood cell differential, fasting glucose, lipids d. Renal function, thyroid function, serum lithium levels Correct Answer : d Rationale : Lithium requires monitoring of renal function, thyroid function, and serum lithium levels to ensure safety and efficacy.
Question 20
c. Clonidine d. Methylphenidate Correct Answer : a Rationale : Risperidone is FDA-approved for irritability in children with ASD, addressing aggression and self-injury.
Question 24
The PMHNP evaluates a 12-year-old with suspected oppositional defiant disorder (ODD). A key diagnostic criterion is: a. Hallucinations b. Persistent pattern of angry/irritable mood c. Manic episodes d. Social withdrawal Correct Answer : b Rationale : ODD is characterized by a persistent pattern of angry/irritable mood, argumentative behavior, and vindictiveness.
Question 25
Which is a risk factor for adolescent suicide? a. Strong family support b. Access to mental health services c. History of bullying d. High academic achievement Correct Answer : c Rationale : A history of bullying is a significant risk factor for adolescent suicide, contributing to emotional distress.
Question 26
The PMHNP uses the Child Behavior Checklist (CBCL) to: a. Diagnose schizophrenia b. Assess behavioral and emotional problems c. Monitor lithium levels d. Evaluate cognitive function
Correct Answer : b Rationale : The CBCL is a standardized tool to assess behavioral and emotional problems in children and adolescents.
Question 27
A 9-year-old with separation anxiety disorder is best treated with: a. Pharmacotherapy alone b. CBT with parental involvement c. Antipsychotic medication d. Inpatient hospitalization Correct Answer : b Rationale : CBT with parental involvement is the first-line treatment for separation anxiety disorder in children.
Question 28
Which medication requires monitoring for agranulocytosis in pediatric patients? a. Fluoxetine b. Clozapine c. Methylphenidate d. Lamotrigine Correct Answer : b Rationale : Clozapine requires monitoring for agranulocytosis due to its risk of severe neutropenia.
Question 29
A 16-year-old with major depressive disorder is prescribed fluoxetine. The PMHNP should warn about: a. Increased appetite b. Suicidal ideation c. Hypotension d. Weight loss Correct Answer : b Rationale : Fluoxetine carries a black box warning for increased suicidal ideation in adolescents, especially early in treatment.
Which statement about pediatric bipolar disorder is true? a. It is rare before age 12 b. It always presents with mania c. It does not require medication d. It is easily distinguished from ADHD Correct Answer : a Rationale : Pediatric bipolar disorder is rare before age 12 and often presents with irritability rather than classic mania.
Question 34
The PMHNP uses the Vanderbilt ADHD Rating Scale to: a. Diagnose autism spectrum disorder b. Assess ADHD symptoms c. Monitor antipsychotic side effects d. Evaluate depression severity Correct Answer : b Rationale : The Vanderbilt ADHD Rating Scale assesses ADHD symptoms in children, completed by parents and teachers.
Question 35
A 13-year-old with obsessive-compulsive disorder (OCD) is prescribed sertraline. The first-line non-pharmacological treatment is: a. Psychoanalysis b. CBT with exposure and response prevention c. Family therapy d. Play therapy Correct Answer : b Rationale : CBT with exposure and response prevention is the first-line non-pharmacological treatment for pediatric OCD.
Question 36
Which is a common side effect of risperidone in children? a. Weight gain b. Hypotension
c. Insomnia d. Decreased appetite Correct Answer : a Rationale : Risperidone commonly causes weight gain in children, requiring monitoring for metabolic effects.
Question 37
A 17-year-old with schizophrenia reports auditory hallucinations. The PMHNP considers: a. Fluoxetine b. Aripiprazole c. Clonazepam d. Methylphenidate Correct Answer : b Rationale : Aripiprazole, an atypical antipsychotic, is effective for treating hallucinations in schizophrenia.
Question 38
The PMHNP evaluates a 6-year-old with suspected autism spectrum disorder. A key diagnostic feature is: a. Hyperactivity b. Restricted, repetitive behaviors c. Frequent mood swings d. Oppositional behavior Correct Answer : b Rationale : Restricted, repetitive behaviors are a core diagnostic feature of autism spectrum disorder.
Question 39
Which ethical principle guides the PMHNP when addressing confidentiality in adolescent therapy? a. Beneficence b. Autonomy c. Justice d. Nonmaleficence
Question 43
A 9-year-old with ADHD is prescribed atomoxetine. The PMHNP should monitor for: a. Weight gain b. Suicidal ideation c. Extrapyramidal symptoms d. Hyperactivity Correct Answer : b Rationale : Atomoxetine carries a black box warning for suicidal ideation in children and adolescents.
Question 44
The PMHNP uses the Strengths and Difficulties Questionnaire (SDQ) to: a. Diagnose schizophrenia b. Screen for emotional and behavioral problems c. Assess cognitive function d. Monitor medication side effects Correct Answer : b Rationale : The SDQ is a screening tool for emotional and behavioral problems in children and adolescents.
Question 45
A 16-year-old with bulimia nervosa is best treated with: a. Antipsychotics b. CBT and SSRIs c. Stimulants d. Mood stabilizers Correct Answer : b Rationale : CBT combined with SSRIs, such as fluoxetine, is the first-line treatment for bulimia nervosa.
Question 46
Which is a risk factor for childhood anxiety disorders? a. High academic achievement b. Parental overprotection c. Regular exercise d. Strong peer relationships Correct Answer : b Rationale : Parental overprotection can contribute to anxiety disorders by limiting a child’s ability to develop coping skills.
Question 47
The PMHNP evaluates a 10-year-old with suspected intellectual disability. The assessment should include: a. IQ testing b. Blood glucose levels c. Thyroid function tests d. Lipid profile Correct Answer : a Rationale : IQ testing is essential for diagnosing intellectual disability, assessing cognitive functioning.
Question 48
A 14-year-old with social anxiety disorder avoids school presentations. The PMHNP recommends: a. Exposure-based CBT b. Antipsychotic medication c. Parent training only d. Benzodiazepines Correct Answer : a Rationale : Exposure-based CBT is the first-line treatment for social anxiety disorder, targeting avoidance behaviors.
Question 49
Which is not a symptom of pediatric bipolar disorder? a. Irritability
Correct Answer : b Rationale : ADHD symptoms must appear before age 12 for diagnosis, per DSM-5 criteria.
Question 53
The PMHNP evaluates a 5-year-old with suspected selective mutism. A key feature is: a. Refusal to speak in specific settings b. Hallucinations c. Aggressive behavior d. Excessive sociability Correct Answer : a Rationale : Selective mutism involves consistent refusal to speak in specific settings, despite normal language ability.
Question 54
Which medication is used to treat nightmares in pediatric PTSD? a. Prazosin b. Fluoxetine c. Methylphenidate d. Lamotrigine Correct Answer : a Rationale : Prazosin, an alpha-1 blocker, is effective for reducing nightmares in pediatric PTSD.
Question 55
A 13-year-old with conduct disorder is at increased risk for: a. Generalized anxiety disorder b. Substance use disorders c. Autism spectrum disorder d. Major depressive disorder Correct Answer : b Rationale : Conduct disorder is strongly associated with an increased risk of substance use disorders in adolescence.
Question 56
The PMHNP uses the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to: a. Screen for ADHD b. Assess OCD severity c. Diagnose schizophrenia d. Monitor lithium levels Correct Answer : b Rationale : The Y-BOCS is a standardized tool to assess the severity of obsessive-compulsive disorder symptoms.
Question 57
A 10-year-old with enuresis is best treated with: a. Antipsychotics b. Behavioral interventions c. SSRIs d. Stimulants Correct Answer : b Rationale : Behavioral interventions, such as bedwetting alarms, are the first-line treatment for enuresis.
Question 58
Which is a core feature of autism spectrum disorder? a. Hyperactivity b. Social communication deficits c. Manic episodes d. Oppositional behavior Correct Answer : b Rationale : Social communication deficits are a core diagnostic feature of autism spectrum disorder.
Question 59
A 16-year-old with panic disorder is prescribed clonazepam. The PMHNP should caution about: a. Weight gain
