Mental Health

Question 1

A patient reports symptoms of restlessness, fatigue, and difficulty concentrating. The provider
determines that these symptoms occur in relation to many events and concerns. What other
things will the provider question this patient about?
a. Ability to manage social situations
b. Body image and eating habits
c. Headaches and bowel habits
d. Occupational performance

Answer 1

ANS: C
This patient has symptoms consistent with generalized anxiety disorder (GAD) in which
feelings occur in relation to many events. Patients with GAD often have headaches and
irritable bowel syndrome. Phobias are linked to particular events and often include social
situations. Patients with obsessive-compulsive disorder (OCD tend to have eating disorders
and difficulty with occupational and academic performance.

Question 2

A patient is diagnosed with panic disorder and begins taking a selective serotonin reuptake
inhibitor (SSRI) medication. Six weeks later, the patient reports little relief from symptoms.
What will the provider do next to manage this patient?
a. Change the medication to buspirone
b. Discontinue the medication
c. Increase the medication dose
d. Refer to a mental health provider

Answer 2

ANS: D
Patients taking SSRIs for anxiety disorders should see effects within 2 to 4 weeks. If patients
have not had good results in 4 to 6 weeks, the provider should change the medication or refer
to a mental health provider. Discontinuing an SSRI abruptly can cause withdrawal symptoms.
Increasing the medication dose will not improve the effects. Buspirone is somewhat useful
only for generalized anxiety disorder (GAD).

Question 3

Which medication is useful in treating both obsessive-compulsive disorder (OCD) and
post-traumatic stress disorder (PTSD)? (Select all that apply.)
a. Benzodiazepines
b. Buspirone
c. Selective serotonin reuptake inhibitors (SSRIs)
d. Serotonin-norepinephrine reuptake inhibitors (SNRIs)
e. Tricyclic antidepressants (TCAs)

Answer 3

ANS: C, D, E
SSRIs, SNRIs, and TCAs are useful in treating both OCD and PTSD. Benzodiazepines and
buspirone are not indicated for either disorder.

Question 4

A patient is seen in clinic 2 weeks after the death of a parent. The patient reports feelings of
sadness and hopelessness and a feeling that the parent is still present, even to the point of
hearing the parent’s voice at times. What will the provider determine from these findings?
a. There is a concern for hypermania.
b. There is a possibility of manic episodes.
c. These are concerning for depression.
d. These are normal grief responses.

Answer 4

ANS: D
These are short-lived symptoms at this point, lasting less than 2 months. Auditory and sensory
hallucinations only in relation to the deceased are normal during intense grief. Hypermania is
an acute, short-lived manic episode. Mania involves abnormal elevation of a person’s mood.
Depression is present when symptoms of grief are more severe and more prolonged

Question 5

A patient is seen frequently over a 9-month period with somatic complaints that are not
related to physical disease. The primary provider notes that the patient has had a 15% weight
loss in the previous 2 months and the patient reports difficulty sleeping. The spouse tells the
provider that the patient seems tired all the time and is irritable with other family members.
What will the provider do initially?
a. Perform a suicide risk assessment
b. Prescribe a selective serotonin reuptake inhibitor
c. Refer the patient for psychotherapy
d. Suggest cognitive-behavioral therapy

Answer 5

ANS: A
For any patients with symptoms of depression, the initial action is to perform a thorough
assessment and evaluate potential suicide risk. SSRIs can be prescribed once a diagnosis is
determined according to diagnostic criteria. Psychotherapy and cognitive-behavioral therapy
may also be prescribed.

Question 6

A college student is brought to clinic by a parent who is concerned about increasingly bizarre
behavior and poor school performance. The provider notes difficulty engaging the patient in
an organized conversation. The patient denies any concerns about behavior. What will the
provider do initially to manage this patient’s symptoms?
a. Admit the patient for inpatient treatment
b. Begin treatment with lithium or lamotrigine
c. Counsel the parent to report any symptoms of depression
d. Schedule an appointment with a psychiatrist

Answer 6

ANS: B
Patients with symptoms of mania should begin treatment with a mood stabilizer and the
primary care provider should initiate treatment for an acute episode. It is not necessary to
admit as an inpatient unless there is indication of harm to the self or others. The primary
provider should refer for psychiatric evaluation but should begin medications as soon as
possible

Question 7

A 17-year-old male is brought to the clinic by a parent who is concerned that the patient has
become more isolated and withdrawn. The patient has expressed suspicions that his teachers
hate him and want him to fail. What will the provider tell this parent?
a. The adolescent should be evaluated by a psychiatrist.
b. The adolescent should be given a trial of antipsychotic medications.
c. These are common adolescent behaviors and will eventually go away.
d. These signs are diagnostic for schizophrenia.

Answer 7

ANS: A
These signs, along with a family history of psychosis, can be predictive of schizophrenia, so
referral for psychiatric evaluation should be made. Unless symptoms are present longer than a
month and the patient is diagnosed, antipsychotic medications are not indicated. Without
evaluation, these behaviors should not be dismissed as normal. While these signs may raise
concerns for schizophrenia, they are not diagnostic.

Question 8

A young male patient is reported to be more withdrawn from his peers than usual and has
dropped out of college and quit his job within the last 5 months. The parent is concerned that
the patient may have schizophrenia because a maternal uncle has the disease. What will the
provider do next?
a. Ask about the patient’s speech and thinking patterns
b. Consider treatment with antipsychotic medications
c. Reassure that classic symptoms of schizophrenia are not present
d. Refer the patient for inpatient psychiatric treatment

Answer 8

ANS: A
In order to diagnose schizophrenia, one or more of the positive signs of delusions,
hallucinations, or disorganized speech must be present. Unless there is a definitive diagnosis,
hospitalization and treatment are not indicated. The patient has some signs of schizophrenia,
so further evaluation is necessary before reassurance can be made.

Question 9

Which are considered “negative” symptoms of schizophrenia? (Select all that apply.)

a. Auditory hallucinations
b. Delusions of persecution
c. Impaired self-care
d. Poor school performance
e. Withdrawing from peers

Answer 9

ANS: C, D, E
Negative symptoms are those related to decrease or loss of normal functions and may include
social withdrawal, impaired self-care, and poor school performance. Hallucinations and
delusional beliefs are things added to normal behaviors and are considered positive symptoms
of schizophrenia.

Question 10

A child who has attention-deficit/ hyperactivity disorder (ADHD) has difficulty stopping activities from beginning other activities at school. The primary care pediatric nurse practitioner understands that this is due to difficulty with the self-regulation component of
A. emotional control.
B. flexibility
C. inhibition.
D. problem solving

Answer 10

B. flexibility. **

Question 11

The primary care pediatric nurse practitioner cares for a preschool-age child who was exposed to drugs prenatally. The child bites other children and has tantrums when asked to stop but is able to state later why this behavior is wrong. This child most likely has a disorder of
A. executive function. 
B. information processing. 
C. sensory processing.
D. social cognition.

Answer 11

A executive function. **

Question 12

The primary care pediatric nurse practitioner uses the Neurodevelopmental Learning Framework to assess cognition and learning in an adolescent. When evaluating
social cognition, the nurse practitioner will ask the adolescent
A. about friends and activities at school.
B. if balancing sports and homework is difficult.
C. to interpret material from a pie chart.
D. to restate the content of something just read.

Answer 12

A. about friends and activities at school. ***

Question 13

The parent of a child diagnosed with ADHD tells the primary care pediatric . nurse practitioner that the child gets overwhelmed by homework assignments, doesn’t seem toknow which ones to do first, and then doesn’t do any assignments. T he nurse practitioner
tells the parent that this represents impairment in which executive function?
A. Activation Correct
B. Effort
C. Emotion
D. Focus

Answer 13

A. Activation**

Question 14

The primary care pediatric nurse practitioner is considering medication options for a schoolage
child recently diagnosed with ADHD who has a primarily hyperactive
presentation. Which medication will the nurse practitioner select initially?
A. Low-dose stimulant
B. Moderatedose stimulant
C. Low-dose nonstimulant
D. Moderatedose nonstimulant

Answer 14

B. Moderate dose stimulant

Question 15

The parent of a preschoolage
child who is diagnosed with a sensory processing disorder (SPD) asks the primary care pediatric nurse practitioner how to help the
child manage the symptoms. What will the nurse practitioner recommend?
A. Establishing a reward system for acceptable behaviors
B. Introducing the child to a variety of new experiences
C. Maintaining predictable routines as much as possible Correct
D. Providing frequent contact, such as hugs and cuddling

Answer 15

C. Maintaining predictable routines as much as possible

Question 16

The primary care pediatric nurse practitioner is performing an examination on
a 5yearold child who exhibits ritualistic behaviors, avoids contact with other children, and has limited speech. The parent reports having had concerns more than 2 years ago about autism but was
told that it was too early to diagnose. What will the nurse practitioner do first?

A. Administer an MCHAT screen to screen the child for communication and socialization delays.
B. Ask the parent to describe the child’s earlier behaviors from infancy through
preschool.
C. Reassure the parent that if symptoms weren’t present earlier, the likelihood of
autism is low.
D. Refer the child to a pediatric behavioral specialist to develop a plan of treatment and management.

Answer 16

B. Ask the parent to describe the child’s earlier behaviors from infancy through
preschool.

Question 17

The primary care pediatric nurse practitioner is examining a 3yearold child
who speaks loudly, in a monotone, does not make eye contact, and prefers to sit on the exam room
floor moving a toy truck back and forth in a repetitive manner. Which disorder
does the nurse practitioner suspect?
A. Attention-deficit/hyperactivity disorder
B. Autism spectrum disorder
C. Executive function disorder D. Sensory processing disorder

Answer 17

B. Autism spectrum disorder

Question 18

The primary care pediatric nurse practitioner is selecting a medication for a
12yearold child who is newly diagnosed with ADHD. The child is overweight, has a history of an atrial septal defect at birth, and reports mild shortness of breath during exercise. What will the nurse practitioner prescribe?

A. A lowdose stimulant medication
B. A nonstimulant medication
C. Behavioral therapy only
D. Cardiovascular prescreening

Answer 18

D. Cardiovascular prescreening

Question 19

The primary care pediatric nurse practitioner is conducting a followup examination on a child who has recently begun taking a lowdose stimulant medication to treat ADHD. The child’s school performance and home behaviors have improved.
The child’s parent
reports noticing a few tics, such a twitching of the eyelids, but the child is unaware of them and isn’t
bothered by them. What will the nurse practitioner recommend?

A. Adding an alphaagonist medication
B. Changing to a nonstimulant medication
C. Continuing the medication as prescribed
D. Stopping the medication immediately

Answer 19

C. Continuing the medication as prescribed

Question 20

During a well child assessment of a preschoolage ch ild, the parent voices concerns that, because the child has behavior problems at school, the child may have a mental
health disorder. Which initial approach will provide the best information?

A. Ask the parent whether other caregivers have voiced similar concerns.
B. Interview the child separately from the parent to encourage sharing of feelings.
C. Take time to actively listen to the parent’s and child’s perceptions of the
problem.
D. Use a validated screening tool to ensure that all aspects of behaviors are evaluated.

Answer 20

C. Take time to actively listen to the parent’s and child’s perceptions of the
problem.

Question 21

The parent of a 4yearold
child reports that the child seems to be having trouble
adjusting to a new day care and reportedly is always engaging in solitary play when the parent arrives to pick up What will the primary care pediatric nurse practitioner do?

A. Ask the parent if the child is slow to warm up to other new situations.
B. Reassure the parent that parallel play is common among preschool-age children.
C. Recommend that the parent spend time encouraging the child to play with others.
D. Suggest that the day care center may be neglecting the child.

Answer 21

A. Ask the parent if the child is slow to warm up to other new situations.

Question 22

A 9 year old child exhibits school refusal and a reluctance to attend sleepovers
with classmates. The parent is concerned because the child has recently begun sleeping in the parents’ bed. Which initial action by the primary care pediatric nurse practitioner is appropriate?

A. Assess for environmental stress, parental dysfunction, and maternal
depression.
B. Ask about recent traumatic events that may have precipitated this behavior.
C. Consider a possible pediatric autoimmune neuropsychiatric disorder cause.
D. Recommend firm insistence on school and activity attendance.

Answer 22

A. Assess for environmental stress, parental dysfunction, and maternal
depression.

Question 23

The parent of a schoolage
child reports that the child becomes frustrated when
unable to perform tasks well and often has temper tantrums and difficulty sleeping. Which disorder
may be considered in this child?

A. Generalized anxiety disorder (GAD)
B. Obsessive compulsive disorder (OCD)
C. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS)
D. Separation anxiety disorder (SAD)

Answer 23

A. Generalized anxiety disorder (GAD)

Question 24

The parent of a school-age
girl reports that the child has difficulty getting ready
for school and is often late because of a need to check and recheck whether her
teeth are clean and her room light has been turned off. What will the primary care
pediatric nurse practitioner recommend to this parent?
A. Cognitive-behavioral therapy
B . Deferral of treatment until symptoms worsen
C. Medication management with an SSRI
D. Referral to a child psychiatrist

Answer 24

A. Cognitive-behavioral therapy

Question 25

A 14 yearold female comes to the clinic with amenorrhea for 3 months. A pregnancy test is negative. The adolescent’s body weight is at 82% of
expected for height and age. The mother reports that her daughter often throws up and refuses to eat most foods. Which condition does the primary care pediatric nurse practitioner suspect?

A. Anorexia nervosa
B. Bulimia nervosa
C. Depression
D. Substance abuse

Answer 25

A. Anorexia nervosa