NUR7350900 - Acute & Chronic Management of Child-Adolescent with Psychiatric Mental (2006 10)
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The World Health Organization reported 90% of adolescents ages 15 to 16 had drank alcohol. The main risk factor reported was a:
- A. Comorbid mental illness
- B. Family drinking problem
- C. Substance use problem
Explanation
Family history of alcohol use or alcoholism is one of the most significant risk factors for adolescent alcohol use. Adolescents with a family history of alcohol use may be more likely to drink and engage in risky drinking behaviors due to genetic, environmental, or social influences.
Correct Answer Is:
B. Family drinking problem
The PMHNP is aware the most important part of assessment includes head-to-toe assessment, developmental assessment, cognitive assessment, and -------- assessment.
- A. Psychosocial
- B. Psychological
- C. Forensic
- D. Substance
Explanation
A psychosocial assessment is a crucial component of the overall assessment process, focusing on the patient’s social environment, relationships, coping mechanisms, and mental health. This assessment helps the PMHNP understand how a patient’s social context influences their mental well-being. Psychological (B) and forensic (C) assessments may be relevant in specific cases, but psychosocial assessment is fundamental. Substance (D) use assessment is also important but not the most comprehensive as part of the broader assessment process.
Correct Answer Is:
A. Psychosocial
Billy, a 14-year-old male, presents for a follow-up; he has been treated for bipolar 1 disorder, most recently manic. He is taking risperidone, although has not been adherent to oral medication. The next best intervention is for the PMHNP to order:
- A. Intramuscular olanzapine
- B. Intramuscular risperidone
- C. Intramuscular ziprasidone
Explanation
For patients who are non-adherent to oral antipsychotic medication, switching to a long-acting injectable (LAI) form of the same medication (in this case, risperidone) is often the most effective intervention. This ensures more consistent medication adherence and provides better symptom control. Since Billy is already on risperidone, switching to intramuscular risperidone would be the next appropriate step to manage his bipolar disorder and prevent further manic episodes.
Correct Answer Is:
B. Intramuscular risperidone
Past family history includes clues for mental disorders therefore, -------- is part of the psychiatric assessment.
- A. Sister history
- B. Brother history
- C. Family history
Explanation
Family history is a critical component of the psychiatric assessment, as it can provide clues about genetic predispositions to mental health disorders. Understanding the mental health history of family members helps the clinician assess potential risk factors and hereditary conditions that may influence the patient’s condition. Sister history (A) and brother history (B) are part of the family history, but "family history" (C) is the most accurate and comprehensive term.
Correct Answer Is:
C. Family history
Evidence-based screening tools are diagnostic aids that:
- A. Use probability methods to improve diagnostic likelihood of a diagnosis
- B. Are a service or toolbox that helps the psychiatric mental health nurse practitioner
- C. Work for the client
Explanation
Evidence-based screening tools are designed to assist healthcare providers, such as psychiatric mental health nurse practitioners, in assessing and diagnosing mental health conditions. These tools provide structured frameworks and are not solely for the client’s benefit, although they help ensure accurate diagnosis and treatment. While they may use probability methods (A) to assist with diagnosis, their primary purpose is as a resource for the practitioner. They do not “work for the client” in the direct sense described in Option C.
Correct Answer Is:
B. Are a service or toolbox that helps the psychiatric mental health nurse practitioner
Nina, a 13-year-old female of minority ethnicity, presents to the clinic for an initial visit and comprehensive psychiatric evaluation. She reports chief complaint, "I do not fit in." Her affect is flat. The PMHNP objective assessment includes gathering additional information, although on first glance, knowing that the majority of clients with flat affect and perception of stigma may be struggling with:
- A. General anxiety
- B. Clinical depression
- C. Thought disorder
Explanation
A flat affect and a perception of stigma are commonly associated with clinical depression. Adolescents who feel disconnected or marginalized (such as Nina, who reports not fitting in) may experience feelings of isolation, low self-esteem, and hopelessness, which are hallmarks of depression. The PMHNP should consider the possibility of depression, particularly when these symptoms are coupled with a flat affect. While general anxiety and thought disorders can also cause emotional distress, depression is the most likely diagnosis based on these initial symptoms. Further assessment will be necessary to confirm the diagnosis and develop an appropriate treatment plan.
Correct Answer Is:
B. Clinical depression
Nina is a 6-year-old female refusing to attend school, stating, "I don't want to go to school," and interactions with teachers are at a minimum. The PMHNP's number one diagnosis is:
- A. Generalized anxiety disorder
- B. Social phobia disorder
- C. Posttraumatic stress disorder
Explanation
Nina's refusal to attend school and limited interaction with teachers suggests social phobia disorder (also known as social anxiety disorder), which involves an intense fear of social situations, particularly those involving performance or evaluation. Children with social phobia often experience significant anxiety in social settings, leading to avoidance behaviors like school refusal. While generalized anxiety disorder and posttraumatic stress disorder (PTSD) can also involve anxiety, the hallmark of social phobia is fear and avoidance of social interactions.
Correct Answer Is:
B. Social phobia disorder
David is an 18-year-old patient who is starting on paroxetine (Paxil) for depression. David's education regarding his medication would include:
- A. Paroxetine may cause intermittent diarrhea.
- B. He may experience sexual dysfunction beginning a month after he starts therapy.
- C. He may have constipation and he should increase fluids and fiber.
- D. Paroxetine has a long half-life so he may occasionally skip a dose.
Explanation
One of the most common side effects of paroxetine (a selective serotonin reuptake inhibitor, or SSRI) is sexual dysfunction, including decreased libido, delayed ejaculation, and anorgasmia. This side effect may become more noticeable after several weeks of use, typically starting after about a month of therapy. The other options are less specific to paroxetine and do not align as closely with known side effects of the medication. For example, diarrhea and constipation are not typically common side effects of paroxetine, and it does not have a long half-life, so skipping doses would not be recommended.
Correct Answer Is:
B. He may experience sexual dysfunction beginning a month after he starts therapy.
First-line therapy treatment for the initial diagnosis of attention deficit hyperactivity disorder (ADHD) is:
- A. Behavioral interventions
- B. Pharmacology
- C. Psychopharmacology
Explanation
For the initial diagnosis of ADHD, behavioral interventions are typically the first-line treatment, especially for younger children. These interventions may include behavior therapy, parent training, and school-based strategies to help the child improve attention, organization, and impulse control. Pharmacological treatments (like stimulants) may be added if behavioral interventions alone are insufficient. Psychopharmacology refers to the use of medications for psychiatric disorders, but it's not the first approach for ADHD unless necessary for symptom management.
Correct Answer Is:
A. Behavioral interventions
The psychiatric mental health nurse practitioner knows about defense mechanisms, therefore when their client is stating "they do not have depression," and has a flat affect, the PMHNP identifies the defense mechanism as:
- A. Displacement
- B. Denial
- C. Projection
Explanation
Denial is a defense mechanism in which a person refuses to acknowledge the reality of a distressing situation. In this case, the client denies having depression despite showing symptoms, such as a flat affect, which is characteristic of depression. Displacement (A) involves redirecting emotions from a threatening object to a safer one, and projection (C) involves attributing one's own undesirable feelings or thoughts to others. Denial is the most appropriate defense mechanism in this scenario.
Correct Answer Is:
B. Denial
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