Deck 30: Neurodevelopmental, Behavioral and Mental Health Disorders

Question 1

The primary care pediatric nurse practitioner is conducting a follow-up examination on a child who has recently begun taking a low-dose stimulant medication to treat attention-deficit/hyperactivity disorder (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 alpha-agonist medication
B) Changing to a non-stimulant medication
C) Continuing the medication as prescribed
D) Stopping the medication immediately

Answer 1

C

Question 2

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 2

A

Question 3

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 related to what process?

A) Executive function
B) Information processing
C) Sensory processing
D) Social cognition

Answer 3

A

Question 4

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) Cognitive-behavioral therapy
C) Family therapy
D) Hospitalization

Question 5

A child diagnosed with attention-deficit/hyperactivity disorder (ADHD) has difficulty stopping activities to begin other activities at school. The primary care pediatric nurse practitioner understands that this is due to difficulty with what self-regulation ability?

A) Emotional control
B) Flexibility
C) Inhibition
D) Problem-solving

Question 6

The primary care pediatric nurse practitioner is examining a 3-year-old 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

Question 7

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 Attention-deficit/hyperactivity disorder (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 8

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 short-term trial of an antidepressant medication
C) Determining suicidal ideation and risk of suicide
D) Referring the adolescent to a mental health specialist

Question 9

The parent of a school-age 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)

Question 10

The primary care pediatric nurse practitioner is performing an examination on a 5-year-old 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 M-CHAT 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.

Question 11

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 do initially?

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.

Question 12

The parent of a child diagnosed with attention-deficit/hyperactivity disorder (ADHD) tells the primary care pediatric nurse practitioner that the child gets overwhelmed by homework assignments, doesn't seem to know which ones to do first, and then doesn't do any assignments. The nurse practitioner tells the parent that this represents impairment in which executive function?

A) Activation
B) Effort
C) Emotion
D) Focus

Question 13

A 13-year-old 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 Attention-deficit/hyperactivity disorder (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.

Question 14

The primary care pediatric nurse practitioner is performing an examination on a 5-year-old 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 M-CHAT 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.

Question 15

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

Question 16

A 14-year-old 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