2021 NURS6660 Walden University Clinical Analysis Final Exam With Answers (75 Solved Questions)

Name: 2021 NURS6660 Walden University Clinical Analysis Final Exam With Answers (75 Solved Questions)
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WALDEN UNIVERSITY NURS 6660 FINAL EXAM
Question 1
In which demographic is depression twice as prevalent in girls as compared to boys?
A. Preschoolers
B. School aged
C. Adolescents
D. All children
Question 2
Andrew is a 14-year-old male who is being managed for bipolar I disorder. He was started on
lithium 6 weeks ago and has achieved a serum level of 1.1 mEq/L according to his most recent
blood work. Andrew says he does not feel any different, but both his parents and teachers
report improvement in his mood. He has been more stable, is getting along better with friends
and siblings, and is even more interested in his schoolwork. The PMHNP plans to maintain
Andrew on this medication and knows that he will need which of the following ongoing
laboratory assessments?
A. Complete blood count, thyroid function tests, and serum calcium
B. Liver function tests, complete blood count, and 12-lead electrocardiogram
C. White blood cell differential, fasting glucose, and fasting lipid profile
D. Comprehensive metabolic panel, complete blood count, and thyroid function tests
Question 3
Confidentiality is a complex topic in the world of child and adolescent psychiatry. The last 40 to
50 years have been characterized by increased attention to this issue and the publication of
various ethical codes and practice position statements by professional organizations. Which of
the following is not a true statement with respect to confidentiality of the child or adolescent
client?
A. The PMHNP should not be concerned with consent for disclosure when child abuse or
maltreatment has occurred.

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states that consent is not required for disclosure.
D. Regardless of code or position statement by any organization, the best approach is when
the child and PMHNP agree on disclosure.
Question 4
Debi is a 15-year-old girl who is currently being treated for depression. Her parents have been
very proactive and involved in her care, and Debi has achieved remission 2 months after
beginning treatment with a combination of pharmacotherapy and cognitive behavioral therapy.
While counseling Debi’s parents about important issues in management, the PMHNP advises
that:
A. There is a > 50% likelihood that Debi’s younger sibling will develop depressive
symptoms
B. The mean length of major depressive episode in adolescents is 4 months
C. 20 to 40% of adolescents who have major depressive disorder will develop bipolar I
within 5 years
D. Adolescent-onset depression typically needs long-term pharmacologic management to
prevent relapse
Question 5
The therapeutic outcomes for children with disorders of written expression are most favorable
when they are characterized by:
Concomitant pharmacotherapy with a psychostimulant to promote attention and focus
Multimodal therapy to include group interaction with peer-to-peer feedback on writing
samples
A variety of tutors who will offer a variety of writing techniques, composition strategies,
and critiques
Intensive, continuous administration of individually tailored, one-on-one expressive and
creative writing therapy

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Question 6
When considering a diagnosis of developmental coordination disorder, the PMHNP knows that
the diagnosis may be associated with:
A. Above-average scores on performance subtests of standardized intelligence testing
B. Below-average scores on verbal subtests of standardized intelligence testing
C. Soft neurologic signs on physical examination such as slight reflex abnormalities
D. Physical findings consistent with neuromuscular disease such as muscular dystrophy
Question 7
Caylee is a 5-year-old girl who is referred for evaluation by child protective services. She was
recently removed from her biological family and placed in foster care, as her home
environment was reportedly unsafe due to conditions of extreme neglect. Her foster mother
reports that Caylee is very quiet and withdrawn and always appears sad and disinterested in her
surroundings; however, she becomes very irritable when anything unexpected or unplanned
occurs. The foster mother became very concerned when it appeared that Caylee was
hallucinating. The PMHNP considers that:
A. Caylee is at high risk for suicide and precautions should be taken
B. The hallucinations are consistent with brief psychotic disorder or schizophrenia
C. The history and reported symptoms are typical of depressive disorder in young children
D. This is a common situation when prepubertal children are removed from the biological
parents regardless of how dysfunctional they are

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Question 8
Children with gender dysphoria typically have higher rates of all the following except:
A. Depression
B. Impulse control disorders
C. Anxiety disorders
D. Eating disorder
Question 9
Eileen is a 23-month-old girl who is being evaluated for autism spectrum disorder because her
pediatrician is concerned about the presence of developmental red flags. She has just a few
words of speech and has not put together any meaningful two-word phrases. While taking a
history from Eileen’s mother the PMHNP learns that for approximately the last 2 months Eileen
has been seen eating paint chips that are peeling off the baseboard and window sills in the family
home; when she sees one she puts it in her mouth. This is a concern because they live in an old
farmhouse and there may be lead-based paint in some of the paint layers. The PMHNP considers
that which of the following is not consistent with a diagnosis of pica?
A. A diagnosis of autism spectrum disorder
B. Symptoms < 6 months duration
C. The pattern of eating
D. Lack of potential consequences
Question 10
The current scholarly consensus is that the etiology of bulimia nervosa is multifactorial to
include biological, sociocultural, family, cognitive-behavioral, and psychodynamic factors.
When considering the etiology of bulimia nervosa, the PMHNP understands that:

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A. Family factors contributing to bulimia nervosa include emotional restraint, tight parental
control of behavior, and avoidance of conflict.
B. Lowered serotonin activity is seen in the brains of patients with bulimia nervosa.
C. There is a disproportionate incidence in childhood sexual abuse in patients with bulimia
nervosa.
D. Cultural influences are much less implicit in the development of bulimia nervosa as
compared to anorexia nervosa.
Question 11
Standardized instructional programs used in the management of reading disorders include all the
following except:
A. The Orton Gillingham and Direct Instructional System for Teaching and Remediation
B. Science Research Associates, Inc. Basic Reading Program
C. Bridge Reading Program
D. Woodcock-Johnson Psychoeducational Battery
Question 12
Which of the following symptom clusters is most likely in a 16-year-old male with major
depressive disorder?
A. Disturbance of mood, loss of interest, and mood-congruent hallucinations
B. Irritability, persistent abdominal complaints, and insomnia
C. Decreased concentration, social withdrawal, and substance abuse
D. Pervasive anhedonia, hopelessness, and severe psychomotor retardation

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Question 13
The PMHNP is working with rural primary care providers to increase awareness of mental health
disorders in infancy and early childhood. The program includes a session on screening for
feeding disorders in infants. If an infant is either observed by the provider or reported by the
parent to frequently suck the tongue rhythmically or appear to strain with his or her back arched
and then swallow, the examiner should consider the possibility of:
A. Gastroesophageal reflux disease
B. Failure to thrive
C. Iron deficiency
D. Inadequate emotional attachment
Question 14
An astute pediatrician has referred Kyle, a 5-month-old infant, for evaluation of rumination
disorder. His mother was concerned because he seemed to “want” to regurgitate every time he
ate and would even seem to “put his hand down his throat” in order to stimulate regurgitation.
Kyle had a thorough evaluation and according to the pediatrician did not have gastroesophageal
reflux or hiatal hernia. The mother-infant relationship appeared to be healthy and, via
assessment, the PMHNP could not identify any clear emotional issues. The primary treatment
strategy for Kyle will likely focus on:
A. Aversive therapies, e.g., squirting lemon juice into Kyle’s mouth when he ruminates
B. Medication therapies to include trials of first-line agents such as metoclopramine,
cimetidine, or haloperidol
C. Psychotherapy for the parents
D. Habit-reversal therapies

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Question 15
The literature indicates that boys whose fathers died before the age of 13 are at a greater
risk for the development of depression as compared to controls. This is consistent with
which general theory of depression etiology?
A. Molecular-genetic
B. Biologic
C. Psychosocial
D. Stress-diathesis
Question 16
Katelyn is a16-year-old girl who presents for therapy with her mother and father. Katelyn was
born with male genitalia but has felt like a female “all of her life.” She says she knew something
was different as far back as she can remember. She always wanted to wear her mother’s clothes
and makeup and play with other girls. Katelyn started dressing and openly identifying as a girl
when she was 13 years old, and her parents are trying to be supportive but they are struggling.
Most recently Katelyn has developed an intimate partner relationship with Jennifer, a 15-year-
old girl who was gender-assigned female at birth and identifies as a female. Katelyn’s father does
not understand the relationship. The PMHNP explains that Katelyn:
A. Is responding to the male hormonal surges of puberty and will ultimately identify with
her physiologic gender
B. Does not have a clear sense of gender identity and may be a candidate for reparative
therapy to correct her gender identity issues
C. Is a transgender female who identifies as lesbian
D. Is a heterosexual male with transvestic disorder
Question 17

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B. Parental neglect
C. Compensation for oral needs
D. Autism spectrum disorder
Question 18
Christine is a 9-year-old female who presents for care after having been placed in the local foster
care system. She has been in and out of foster care for the last 4 years after her parents were
killed in an automobile accident. Christine has been placed in a variety of homes and residential
care facilities. The PMHNP recognizes that Christine is at high risk for:
A. Dissociative disorders
B. Post-traumatic stress disorder
C. Impulse-control disorder
D. Attachment disorder
Question 19
While the core features of schizophrenia are essentially the same in children as they are in adults,
the presentation or characterization is sometimes very different given developmental issues.
Unlike adults with schizophrenia, children with schizophrenia do not have:
A. Classic positive symptoms
B. Poverty of speech content
C. Social rejection
D. Delusions of persecution

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Question 20
The PMHNP is working with a couple who has been trying for years to conceive and is now
ready to pursue adoption as an option. They are considering all possibilities; private vs.
government-mediated adoption, adopting from another country, adopting a child of a different
race or ethnicity, adopting an older child rather than an infant, and adopting a child who is
currently in foster care vs. one who lives in an orphanage. While counseling this couple, the
PMHNP advises them that:
A. Younger children adopted from foster care settings have the best outcomes
B. Children adopted from abuse and neglect situations have better psychological adaptation
than those adopted as newborns
C. Transracial adoptions have demonstrated greater disruptions as compared to same-race
adoptions
D. Adoptions into families as an only child are more successful than those into families with
biological children
Question 21
Mel is a 15-year-old male with a complex psychiatric assessment. He has a long history of mood
instability, behavior problems, and trouble with schoolwork. He was an extremely active child
who, at one time, was put on medication for hyperactivity. After a comprehensive evaluation, the
PMHP recognizes that he meets diagnostic criteria for both bipolar I disorder and attention
deficit hyperactivity disorder (ADHD). The most successful approach to his management is
likely to begin with:
A. Pharmacotherapy for ADHD
B. Pharmacotherapy for bipolar I
C. Parental training and behavioral interventions for ADHD
D. Family-focused psychoeducational (FFT-A) for bipolar I

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Question 22
Bruce and Debbie have made an appointment for a psychiatric consultation for what amounts to
psychiatric genetic counseling. Bruce is 31 years old and Debbie is 28 years old. They have been
married for 3 years and want to have children. Debbie is worried because she has a diagnosis of
schizophrenia. Her symptoms first became evident when she was in her junior year of college;
fortunately, she knew about the disease due to family history and sought care quickly. She has
been very open with Bruce, and they are both well informed about the disease. Debbie is an only
child and her father had schizophrenia that was not well controlled. He committed suicide when
she was 15 years old. Debbie takes olanzapine and feels well overall. She has a part-time job,
functions well, but is concerned about the genetic nature of her disease. Counseling for Bruce
and Debbie includes which of the following pieces of information?
A. Schizophrenia is up to eight times more prevalent in first-degree relatives as compared to
the general population.
B. Schizophrenia has been isolated to chromosome number 5 and antenatal testing is
available to predict genetic predisposition of the fetus.
C. Debbie’s age of onset is more highly correlated with incidence in her offspring as
compared to early-onset schizophrenia.
D. Environment is at least as important as genetics with respect to expression of
schizophrenic symptoms.
Question 23
The PMHNP is working with a pediatrician colleague on a journal article to increase awareness
and improve diagnostic strategies for early-onset bipolar disorder. Based upon a review of the
longitudinal research on this disorder, the literature review of this article should include all the
following except:
A. Recovery rates are lower when bipolar disorder has an early-childhood onset
B. Early-onset bipolar disorder presents a greater likelihood of mixed states and rapid
cycling as compared to adolescent and adult onset
C. Higher socioeconomic status and lifetime psychosis are predictors of more rapid cycling
in early-onset bipolar disorder
D. There is a more frequent conversion from bipolar II to bipolar I in childhood as
compared to adults

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Question 24
Treatment of early-onset schizophrenia can be challenging due to the paucity of evidence-based
support for various pharmacotherapeutics and nonpharmacologic interventions. In a recent study
comparing olanzapine to clozapine, outcomes were assessed with the Clinical Global Impression
of Severity of Symptoms Scale and Schedule for the Assessment of Negative/Positive
Symptoms. Clozapine was found to demonstrate statistically significant superiority in which
outcome measure?
A. Alleviating negative symptoms
B. Occurrence of extrapyramidal effects
C. Sustained remission of symptoms
D. Remission of hallucinations and delusions
Question 25
Benjamin is a 4-year-old male who is being evaluated because his mom is afraid that he may be
schizophrenic. There is a history of schizophrenia in the mother’s family; her maternal aunt, one
sister, and one of her brother’s children were all diagnosed with schizophrenia. Today she reports
that Benjamin has episodes during which he appears to be hallucinating. Sometimes he seems to
see things that are not there, and other times he actually talks with and plays with imaginary
people. The PMHNP continues to gather information from the mother and Benjamin and plans to
do some observation of Benjamin during play. When considering a diagnosis of early-onset
schizophrenia, the PMHNP considers all of the following except:
A. There are virtually no reports of schizophrenia onset before age 5
B. Hallucinations are significantly more predictive of schizophrenia than delusions in young
children
C. Benjamin’s symptoms are more likely a consequence of developmental immaturity
D. Benjamin’s family history should always be considered, but at this point the diagnosis is
very unlikely

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2021 NURS6660 Walden University Clinical Analysis Final Exam With Answers (75 Solved Questions)

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