Deck 19: Coping and Stress Tolerance: Mental Health and Illness

Question 1

A newly divorced mother of a toddler reports that the child began having difficulty
sleeping and nightmares along with exhibiting angry outbursts and tantrums 2 months prior. The primary care pediatric nurse practitioner learns that the child refuses to play with usual playmates
and often spends time sitting quietly. What will the nurse practitioner doinitially?
A. Ask the mother about the child's relationship with the father.
B. Consult with a child psychiatrist to prescribe medications.
C. Recommend cognitive behavioral or psychodynamic therapy.
D. Refer the family to a child behavioral specialist for counseling.

Answer 1

Ask the mother about the child's relationship with the father.

Question 2

A 13­year­old child has exhibited symptoms of mild depression for several weeks.
The parent reports feeling relieved that the symptoms have passed but concerned that the child now seems to have boundless energy and an inability to sit still. What will the primary care pediatric nurse practitioner do?
A. Administer an ADHD diagnostic scale and consider an ADHD medication.
B. Consult with a child psychiatrist to prescribe an antidepressant medication.
C. Reassure the parent that this behavior is common after mild depressive symptoms
D. Refer the child to a child psychiatrist for evaluation of bipolar disorder.

Answer 2

Refer the child to a child psychiatrist for evaluation of bipolar disorder.

Question 3

An adolescent has recently begun doing poorly in school and has stopped
participating in sports and other extracurricular activities. During the history interview, the adolescent reports feeling tired, having difficulty concentrating, and experiencing a loss of appetite for the past few weeks but cannot attribute these changes to any major life event. Which is an important next step in managing this patient?
A. Administering a diagnostic rating scale for depression
B. Considering a short­term trial of an antidepressant medication
C. Determining suicidal ideation and risk of suicide
D. Referring the adolescent to a mental health specialist

Answer 3

Determining suicidal ideation and risk of suicide

Question 4

A middle­school­age child is skipping school frequently and getting poor grades
since the child's father was killed while deployed in the military. How will the primary care pediatric nurse practitioner manage this situation?
A. Prescribe short­term antidepressants for this situational depression.
B. Refer the child to a mental health specialist for evaluation and treatment.
C. Schedule extended appointments for counseling and mental health interventio.
D. Suggest that the child have close follow­up by a school counselor.

Question 5

A 9­year­old 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.

Question 6

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 the child. 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 preschool­age 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.

Question 7

The primary care pediatric nurse practitioner attempts to learn more about the emotional health of an 18­month­old child through which assessment strategy?
A. Asking the child to tell a story using dolls and other props
B. Asking the child to draw a picture of him­ or herself and other family members
C. Interviewing the child separately from caretakers and parents
D. Observation of the child with caretakers in structured and unstructured situations

Question 8

During a well child assessment of a preschool­age child, 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.

Question 9

The parent of a school­age 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. Cognitive­behavioral therapy
B. Deferral of treatment until symptoms worsen
C. Medication management with an SSRI
D. Referral to a child psychiatrist

Question 10

The parent of a preschool­age child reports that the child often appears anxious
and nervous and that this is associated occasionally with a rapid heart rate and tremors. What is the best type of referral that the primary care pediatric nurse practitioner could recommend?
A. Cognitive­behavioral therapy
B. Family therapy
C. Medication therapy
D. Play therapy

Question 11

The parent of a school­age child is concerned because the child has started to
express anger about a grandparent's death even though this occurred when the child was a toddler. What will the primary care pediatric nurse practitioner tell the parent?
A. Anger is an abnormal reaction to bereavement and loss in this age child.
B. Counseling is needed since the child has had sufficient time to resolve this issue.
C. Grief and bereavement lasting longer than a year may require medication.
D. The significance of this loss must be reworked at each developmental level.

Question 12

A child has a difficult temperament. What will the primary care pediatric nurse practitioner tell the parent about managing this child's behavior?
A. A difficult temperament is its own risk factor for maladjustment disorders.
B. Children with difficult temperaments need strict adherence to rules.
C. Having a difficult temperament limits intelligence and emotional maturity
D. It is important for the parent to learn to manage criticism and power struggles.

Question 13

The parent of a school­age child reports that the child doesn't like being alone in
rooms because of a fear of aliens hiding in closets. What will the primary care pediatric nurse practitioner tell the parent?
A. "Fear of imaginary creatures does not usually occur at this age."
B. "I may need to refer your child to a pediatric mental health specialist."
C. "Your child is expressing normal fears for a school­age child."
D. "Your child may be watching too much violence on television."

Question 14

The parents of a 4­year­old boy are concerned because he has begun twisting
and pulling out his hair, especially when he is tired or stressed. What will the primary care pediatric nurse practitioner recommend as part of an initial approach to treat this behavior?
A. Consultation with a pediatric behavioral specialist
B. Cutting his hair so that it is too short to pull
C. Long­term anti­streptococcal prophylaxis
D. Medication with risperidol or clonidine

Question 15

A toddler has begun hitting and biting other children at a day care center and is
exhibiting temper tantrums and bad language at home. The parent reports that these behaviors began shortly after a sibling was born. What will the primary care pediatric nurse practitioner do?
A. Advise the parent that the child is exhibiting early symptoms of ADHD.
B. Engage the parent in positive parenting strategies to facilitate appropriate child coping.
C. Recommend evaluating the child for conduct or oppositional defiant disorder.
D. Suggest putting the child in another day care center to ameliorate the problems.

Question 16

An adolescent is diagnosed with major depression, and the mental health
specialist has prescribed fluoxetine. What other treatment is important to protect against suicide risk?
A. Addition of risperidone therapy
B. Cognitive­behavioral therapy
C. Family therapy
D. Hospitalization

Question 17

A 14­year­old 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

Question 18

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. Obsessive­compulsive disorder (OCD)
C. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS)
D. Separation anxiety disorder (SAD)

Question 19

During a well child examination on a 4­month­old infant, the primary care pediatric
nurse practitioner evaluates mental health issues. Which statement by the parent indicates a potential problem with the parent­infant relationship?
A. "I can sense a difference in my baby's cries."
B. "I let my baby cry a while to learn to be patient."
C. "My baby prefers to nurse in a darkened room."
D. "My baby seems very sensitive to loud noises."