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NR606 FINAL EXAM QUESTIONS & DETAILED ANSWERS
(WELL VERIFIED) ALREADY GRADED A+
Steps for Obtaining Informed Consent - CORRECT ANSWER >>> - Assess pt ability to
understand medical info, tx options, to make a voluntary decision.
- Present relevant info with accuracy and sensitivity:
- diagnosis
- nature & purpose of tx options
- benefits, risks, burdens of all tx options, including forgoing tx
- Document informed consent conversation in the medical record, including all consent forms.
Underlying assumptions for child and adolescent psychotherapy -^ CORRECT ANSWER
>>> Developmental considerations
Family involvement Systems involvement Resiliency Underlying assumptions for child and adolescent psychotherapy: Developmental considerations
- CORRECT ANSWER >>> - developmental level will impact how they:
- reason
- approach relationships
- regulate emotion and behavior
- communicate
- Developmental considerations
- inform the diagnostic process
- guide tx planning
Underlying assumptions for child and adolescent psychotherapy: Family involvement -
CORRECT ANSWER >>> - Family involvement in tx & decision-making
- a norm in child and adolescent psychotherapy
- invite parents to share the hx of the child or adolescent's chief complaint & prior tx, medical & developmental hx, & behavioral info privately with the therapist ahead of the session
- avoid feelings of criticism or discouragement
- collaborate with parent or caregiver as a tx partner
Underlying assumptions for child and adolescent psychotherapy: Systems involvement -
CORRECT ANSWER >>> - Therapists must consider the systems that surround children &
adolescents & promote their development
- family
- school
- peers
- the community
- Therapy can help promote the child/adolescent's socioemotional competence - help develop a community support system
Underlying assumptions for child and adolescent psychotherapy: Resiliency - CORRECT
ANSWER >>> - therapist work to promote resiliency in children & adolescents
- using strength-based orientation
- supports:
- functioning
- Focuses on increasing insight & awareness regarding substance use & motivation toward behavioral change
- Referral
- Guidance to tx provides those identified as needing more extensive tx with access to specialty care
Medication-Assisted Treatment (MAT) - CORRECT ANSWER >>> Treatment for opioid use
disorder combining the use of medications (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies.
Mental health and youth - CORRECT ANSWER >>> - 13% of children ages 8-15 experience a
mental health condition
- 50% of children ages 8-15 experiencing a mental health condition do not receive tx
- 13 - 20% of children living in the U.S. (1 out of 5 children) experience a mental health condition in a given year
- 17% of high school students seriously consider suicide
- 1/2 of all lifetime cases of mental illness begin by age 14
Barriers to Mental Health Treatment in Children and Adolescents -^ CORRECT ANSWER
>>> - lack of sufficient information or access to services
- stigmas or negative perceptions towards mental health services
- many drop out before receiving effective treatment, often due to:
- poverty
- language barriers
- living in communities with scarce resources
- stressors such as
➣problems in the family ➣violence in the community ➣unstable housing ➣unemployment ➣food insecurity
- Cost
- scheduling conflicts
- long waitlists for services
- high staff turnover
Prescribing Considerations for Children and Adolescents - CORRECT ANSWER >>> physiologic
factors impact pediatric med selection & dosing
- Children, more rapid metabolism than adults, may require larger dose of med per unit of body weight
- Around puberty, pharmacokinetic properties reach adult parameters
- dosing after puberty may need to be decreased
- Developmental considerations
- attuned to signs of adverse effects, younger children may not be able to communicate complaints Kassia, a 5-year-old, is prescribed a stimulant medication for ADHD (Attention Deficit Hyperactivity Disorders) for the first time. Consider Piaget's stages, match the developmentally-appropriate education statements with the correct client: "It's kind of like you've got a great bike. The brakes just need some fixing. The medication is like fixing the brakes."
"It's kind of like you've got a great bike. The brakes just need some fixing. The medication is like fixing the brakes." "This medication can help you ignore distractions so you can complete tasks. They can also help
with self-control, which may help you get along better with your frien - CORRECT ANSWER
>>> "This medication can help you ignore distractions so you can complete tasks.
They can also help with self-control, which may help you get along better with your friends and parents. Do you have any concerns about taking the medication?" Rationale: Tamika is in the Formal Operational stage. This stage typically occurs at age 12 and up. Adolescents and young adults begin to reason abstractly and can consider hypothetical problems. They begin to think more about moral, philosophical, ethical, social, and political issues.
Addressing Parental Concerns: Collaborative Treatment Plans - CORRECT ANSWER >>> - tx
plans for children typically made in collaboration with parents or guardians
- Collaboration between the PMHNP, clients, and families when creating the treatment plan is key to ensuring the plan meets the client's needs and is comfortable and manageable for the family
Ethical Considerations in the Treatment of Children and Adolescents -^ CORRECT ANSWER
>>> Privacy and HIPAA
Informed Consent Mandatory Reporting
Ethical Considerations in the Treatment of Children and Adolescents: Privacy and HIPAA -
CORRECT ANSWER >>> - parents have right to req access to a minor's mental health record,
including symptoms, diagnosis, tx plan
- circumstances may limit that right
➣see HIPAA fact sheet
Ethical Considerations in the Treatment of Children and Adolescents: Informed Consent -
CORRECT ANSWER >>> - Parents may decide whether to allow tx child is unable to provide
true informed consent
- children may not be able to give legal consent, should be included in discussions about med & tx whenever possible
Ethical Considerations in the Treatment of Children and Adolescents: Mandatory Reporting -
CORRECT ANSWER >>> - PMHNPs mandated reporters in most states
- required to report suspicions about abuse or neglect to the appropriate authorities
- federal & state statutes include stipulations related to mandatory reporting
- PMHNPs responsible for following all relevant statutes in their state of practice
most common complication during the perinatal period? -^ CORRECT ANSWER^ >>> Mental
health problems
maternal mental health - CORRECT ANSWER >>> - Up to 1 in 5 women will suffer from a
maternal mental health disorder like postpartum depression
- <15% of women receive tx
- 1 in 7 will experience depression during pregnancy
- Up to 50% of women living in poverty will suffer from a maternal mental health disorder
- Maternal mental health disorders impact the whole family, not just moms
- More than 600,000 women will suffer from a maternal mental health disorder in the U.S. ever year
- discuss pts intended method of birth control
- contingency plan for unplanned pregnancy
- decision made to D/C medication, drugs should be tapered whenever possible
- Communication throughout the pregnancy is crucial to ensure client safety if symptoms worsen
- physiologic changes during pregnancy impact pharmacokinetics of many meds
- increase blood plasma level may increase the distribution volume of certain meds
- Hormonal changes in CYP450 may increase or decrease drug metabolism • Increased renal blood flow & GFR may speed the excretion
Prescribing Considerations in Maternal Mental Health Tx: Lack of Evidence - CORRECT
ANSWER >>> - psychoactive medications in the perinatal period
- paucity of evidence regarding the true risks for the pregnant client and developing fetus ➣limited as pregnant women and newborns are frequently excluded from medication research Prescribing Considerations in Maternal Mental Health Tx: Switching Medications During
Pregnancy - CORRECT ANSWER >>> - switching meds during pregnancy can create a high risk
for destabilization of mental illness
- puts both the client and fetus at risk for stress & trauma
- increases the absolute # of substances to which the fetus is exposed ➣may increase risk for adverse outcomes
- If stable on current med regimen, typically better to continue current regimen Allie is a 26-year-old who has been receiving treatment for bipolar I disorder for 3 years. Her symptoms have been in remission with lithium 500 mg twice daily. She also completed 12 weeks of interpersonal and social rhythm therapy (IPSRT) upon diagnosis and used the life charting methodology to track her symptoms. She calls her PMHNP and states "I just found out I'm pregnant. My partner and I were not expecting this, but we are excited! I am worried about
what lithium will do to my baby. Sh - CORRECT ANSWER >>> schedule an appointment for
Allie and her husband to discuss a treatment plan as soon as possible ask Allie to continue taking lithium at the current dose for now
Which of the following should be included in the discussion and documentation of the call with Kenya? Select all that apply.
rare adve - CORRECT ANSWER >>> rare adverse effect of persistent pulmonary hypertension
in the neonate common adverse effect of postnatal abstinence syndrome potential risks of discontinuing treatment to both mother and baby decision to continue treatment Rationale: The PMHNP should disclose all common adverse effects and discuss serious adverse effects associated with the medication, regardless of incidence. The discussion should include the potential risks to both mother and baby if the medication is discontinued. Documentation should include the client's decision whether to continue or discontinue treatment. Since fluoxetine is not a high-risk medication for pregnancy, the PMHNP need not refer the client to a perinatal psychiatrist for medication management. Pregnancy Safety Considerations for Common Mental Health Treatment: Meds for Depression &
Anxiety - CORRECT ANSWER >>> - SSRIs are first-line treatments for depression and anxiety
during pregnancy
- SNRIs, tricyclic's, & bupropion are also considered safe tx options
- most common adverse effect with SSRIs & SNRIs is neonatal withdrawal syndrome
- Symptoms: tremors, high-pitched crying, disturbed sleep (peaks 2-4 days after birth)
- impacts up to 30% of babies born to mothers who take antidepressant medication
- no evidence D/Cing or tapering dosages in last trimester reduces risk to infant
- Paroxetine may increase risk of atrial septal defects
- Benzodiazepines taken with caution for anxiety
- risk of newborn toxicity must be considered and monitored if used
- Symptoms: sedation, floppy muscle tone, potential breathing issues at birth Pregnancy Safety Considerations for Common Mental Health Treatment: Meds for Bipolar
Disorder - CORRECT ANSWER >>> - Lamotrigine considered safe during pregnancy
- may not be effective for manic episodes
- Lithium exposure during first trimester has small but significant risk of cardiac malformations
- increases with higher doses
- risks and benefits carefully considered, Consider the gestational age of the embryo and fetus
- AVOID DURING PREGNANCY
- valproic acid and carbamazepine are considered teratogenic
Pregnancy Safety Considerations for Common Mental Health Treatment: Meds for Psychosis -
CORRECT ANSWER >>> - atypical antipsychotic medications, particularly olanzapine and
quetiapine
- increased risk of gestational diabetes ➣D/Cing may not decrease the risk
- increased risk of large for gestational age infants
- Olanzapine increase the risk of musculoskeletal malformations in infants
- Risperidone & quetiapine are the most used antipsychotics during pregnancy
- Neither cause malformations
- Antipsychotic meds may cause neonatal withdrawal symptoms
- close monitoring of newborn several days after delivery Johnita has been taking sertraline 100 mg daily for 4 years for major depressive disorder. Her symptoms have fluctuated over the past year. She is 10 weeks pregnant.
Rationale: Lithium exposure during the first trimester has a small but statistically significant risk of cardiac malformations; the risk increases with higher dosages of the medication. Obtaining serum lithium levels before tapering the dose is indicated since Alexandra has bipolar I disorder and is stable. The development of the heart begins as early as the third week of gestation with the 4-chamber fetal heart formed by gestational week 7. By the time Alexandra is weaned the risk has passed as the heart is already formed. Although lamotrigine is considered safe during pregnancy, it may not be appropriate for clients who have experienced mania in the past. Saoirse takes aripiprazole 30 mg daily for a diagnosis of schizophrenia. She has taken the medication throughout her pregnancy and is now 34 weeks pregnant. She is concerned about the risks of neonatal withdrawal syndrome once her child is delivered. Which of the following is the most appropriate recommendation for Saoirse? continue taking aripiprazole 30 mg daily taper aripiprazole dose over 2 weeks to 15 mg daily and then increase to 30 mg after delivery
discontinue aripiprazole at 38 weeks - CORRECT ANSWER >>> continue taking aripiprazole
30 mg daily Rationale: Although neonatal withdrawal syndrome can occur in newborns who are exposed to second-generation antipsychotics, reducing or discontinuing aripiprazole or switching to another antipsychotic medication may cause destabilization in the client. The infant may need a few days of additional monitoring after delivery, but the client should remain on her optimized dose.
Breastfeeding - CORRECT ANSWER >>> - American Academy of Pediatrics advocates
breastfeeding through the first 6 months of life
- most psychotropic medications pass into breast milk
- If infant exposed to med in utero, may discuss continuing med during breastfeeding, unless has severe side effects for infant
- req new or additional prescriptions while breastfeeding
- discuss whether benefits of breastfeeding outweigh the risks of exposure to the infant
- bottle feeding may be the best option
- Pts must be educated to support informed choice & their preferences must be supported
Safe for Breastfeeding - CORRECT ANSWER >>> - SSRIs
- Benzodiazepines
- Valproic acid
- Quetiapine
Safe for Bottle Feeding - CORRECT ANSWER >>> - Lithium
Substance Use Disorders During the Perinatal Period - CORRECT ANSWER >>> - Perinatal
SUDs are an urgent public health crisis
- increasing across all groups of childbearing people ➣rates rising rural or low-income communities & those with Medicaid coverage for maternity care
- greatest risk for life-threatening outcomes of SUDs is among people of color.
- hallmark symptoms of SUDs: behavioral, physical, and psychological dependence
- most used substance in the perinatal period is tobacco, followed by alcohol, cannabis, and other illicit drugs
- use of prescription & illicit opioids also increasing
- In US: 70, 000 maternal overdose deaths in 2018, 69% were related to opioid use
- CDC: no safe time to drink during pregnancy, no safe quantity of alcohol to consume while pregnant or trying to get pregnant
- 1st trimester exposure correlates with the most significant alcohol-related birth outcomes
- increased risk for miscarriage, stillbirth, congenital anomalies, low birth weight, small for gestational age, and preterm delivery
- Lifelong effects of AUD on children:
- fetal alcohol spectrum disorders (FASDs)
- neurodevelopmental & CNS deficits
- speech & language challenges
- cognitive & behavioral deficits
- impaired executive functioning
- psychosocial difficulties in adulthood
fetal alcohol spectrum disorders (FASDs) - CORRECT ANSWER >>> Up to 1 in 20 US school
children may have FASDs
- Physical Issues:
- low birth weight and growth.
- problems with heart, kidneys, and other organs.
- damage to parts of the brain. Leads to...
- Behavioral and intellectual disabilities:
- learning disabilities and low IQ
- hyperactivity
- difficulty with attention
- poor ability to communicate in social situations
- poor reasoning and judgment skills Can lead to...
- Lifelong issues with:
- school and social skills
- living independently
- mental health
- substance use
- keeping a job
- trouble with the law
Health Risks Associated with SUDs: Cannabis - CORRECT ANSWER >>> - often combined with
other substances
- associated with:
- preterm labor
- low birth weight
- small for gestational age deliveries
- adverse effects on fetal and adolescent brain growth
- adverse effects on executive functioning skills
- behavioral problems
- adverse effects on academic achievement
- All forms of cannabis have adverse effects, even medical marijuana
Marijuana Possible Effects on Your Fetus - CORRECT ANSWER >>> - Disruption of brain
development before birth
- Smaller size at birth; higher risk of still birth
- Higher chance of being born too early, especially when a woman uses both marijuana and cigarettes during pregnancy
- Harm from second-hand marijuana smoke: Behavioral problems in childhood and trouble paying attention in school
