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NR 606 WEEK 8 FINAL EXAM 2025/2026 COMPLETE
QUESTIONS AND 100% CORRECT ANSWERS WITH
RATIONALE
“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"
"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"
"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 -Anxiety & depression have risen 37% in teen girls. This will increase the number of women suffering postpartum depression in the future -Rates of depression are more than doubled in Black moms due to cumulative effects of stress called weathering"
"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. Which of the following is the most appropriate recommendation for Johnita? continue sertraline 100 mg daily decrease sertraline to 50 mg daily
increase sertraline to 150 mg daily
discontinue sertraline - CORRECT ANSWER continue sertraline 100 mg daily
Rationale: Sertraline is considered a safe medication during pregnancy. The client's symptoms have fluctuated on her current medication dose; therefore, decreasing the dose may cause a relapse of symptoms."
"Health Risks Associated with SUDs: Tobacco - CORRECT ANSWER No tobacco product is
considered safe for use during the perinatal period -Smoking-related pregnancy complications:
- ectopic pregnancy
- placental abruption
- placenta previa
- fetal mortality
- stillbirth
- preterm birth
- low birth weight infants -Smoking-related effects on neonates:
- sudden infant death syndrome
- birth malformations ➣oral clefts ➣neural tube defects -Smoking-related effects on infants, children, and adolescents:
- asthma
- cognitive impairment
- lower respiratory illness
- ADHD
- central nervous system tumors"
"Health Risks Associated with SUDs: Alcohol - CORRECT ANSWER -Drinking while pregnant
costs the US $5.5 billion -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)
"Madden (2019) has proposed a new category of stigma: intervention stigma - CORRECT
ANSWER -"Individuals working in [medication-assisted treatment] MAT experience
discrimination and prejudice from other healthcare professionals -discrimination & prejudice stem at times from stigma toward addiction diagnoses"
"Structural Stigma in U.S. Drug Policies - CORRECT ANSWER -nation's drug policies tend to
follow 1 of 2 diff. aims:
- offering medical care such as MAT
- criminalizing behaviors associated with substance use -Fear of legal repercussions and the involvement of children's services may lead women to avoid reporting substance use
of states with punitive policies/requirements for providers to report suspected prenatal drug
use has more than doubled in the last decade, resulting in poor health outcomes"
"State Policy on Substance Use During Pregnancy - CORRECT ANSWER -authorizing civil
commitment -criminalizing the behavior as child abuse or neglect -requiring providers to notify child protective services when an infant is affected by illegal substance abuse -requiring providers to report or test for prenatal drug exposure, which is permissible evidence in child-welfare proceedings"
"In 2023, the Guttmacher Institute reported: - CORRECT ANSWER -24 states and the District
of Columbia consider prenatal substance use to be child abuse -3 states and the District of Columbia consider it grounds for civil commitment -25 states and the District of Columbia mandate provider reporting of suspected prenatal drug use -8 states require providers to test for prenatal drug exposure if drug use is suspected -19 states have created or funded drug treatment programs specifically for pregnant people -10 states prohibit publicly funded drug treatment programs from discriminating against pregnant people" "Of pregnant women who were anonymously tested for drug use, the prevalence of use was found to be similar between Black and White women, but Black women were _____ times more likely to
be reported to law enforcement. - CORRECT ANSWER 10x"
"_______________ women suffer from higher SUD rates compared to other racial and ethnic groups and are disproportionately affected by criminalization laws at the federal, state, and tribal levels.
- CORRECT ANSWER Indigenous"
"Consistent use of medication for OUD treatment during pregnancy is significantly lower for
________________________. - CORRECT ANSWER women of color"
"substance use during pregnancy Assessment and Screening - CORRECT ANSWER -The U.S.
Preventative Services Task Force (USPSTF) and ACOG have recommended the Brief Intervention and Referral to Treatment (SBIRT) approach
- screen for substance use during the perinatal period -Validated screening tools for substance use during pregnancy
- Substance Use Risk Profile-Pregnancy scale (SURP-P)
- 4P's Plus ➣can also include validated screening questions for depression & domestic violence"
"prefrontal cortex controls: - CORRECT ANSWER attention, memory, mood, & personality"
"MDD - CORRECT ANSWER -primary feature of MDD is the occurrence of at least 1 episode of
major depression lasting at least 2 weeks -must experience 5 or more of the following symptoms in 2 weeks to be diagnosed with a major depressive episode:
- feeling low most of the day for most days
- decreased interest in activities
- substantial weight loss, significant change in appetite
- fidgeting, random movement (i.e. pacing)
- decreased energy
- sense of guilt or worthlessness
- lack of focus or ability to make decisions
- repeated thoughts of death and suicide"
"Depression meds - CORRECT ANSWER -SSRIs
-SNRIs -TCAs -MAOIs"
"Selective Serotonin Reuptake Inhibitors (SSRIs) - CORRECT ANSWER -Action:
- inhibits the reuptake of serotonin -Ex:
- citalopram
- escitalopram
- fluoxetine
- paroxetine
- sertraline
thyroid function liver function tests (LFTs) renal function hemoglobin A1C (HbA1C) complete blood count (CBC)
serum lithium level - CORRECT ANSWER thyroid function
serum lithium level renal function Rationale: Lithium has a narrow therapeutic index and should be monitored carefully. Serum levels should be evaluated 5 days after any dosage change and regularly at 6-month intervals. Lithium can cause renal and thyroid toxicity. Renal and thyroid function should be evaluated every 6 months."
"consequences of untreated MMHDs: Impact on the Mother - CORRECT ANSWER • Have
poor nutrition
- Use substances such as alcohol, tobacco, or drugs
- Experience physical, emotional, or sexual abuse
- Be less responsive to baby's cues
- Have fewer positive interactions with baby
- Experience breastfeeding challenges
- Question their competence as mothers"
"consequences of untreated MMHDs: Impact on the Child - CORRECT ANSWER • Low birth
weight or small head size
- Pre-term birth
- Longer stay in the NICU
- Excessive crying
- Impaired parent-child interactions
- Social-emotional, cognitive, language, motor, & adaptive behavior development
- Untreated mental health issues in the home may result in an Adverse Childhood Experience, which can impact the long-term health of the child." "terms used to refer to the conditions women experience during pregnancy and the first
postpartum year: - CORRECT ANSWER -postpartum depression (PPD)
-perinatal (or antenatal, prenatal, or postpartum) depression & anxiety -perinatal mood disorders (PMDs) or perinatal mood & anxiety disorders (PMADs) -maternal mental health disorders"
"Barriers to Maternal Mental Health Care - CORRECT ANSWER -inconsistencies in
terminology can lead to mistreatment in maternity care -classification of maternal mental health disorders in the (DSM-5-TR)
- depressive disorder specifier "with peripartum onset" timeframe for using the specifier remains confined to the first four weeks after birth"
"Risk Factors for MMHDs - CORRECT ANSWER -Smoking
-Lack of social support -Poor relationship quality -Pregnancy complications -Personal or family history of depression -History of physical or sexual abuse -Unintended pregnancy -Life stress -Chronic physical conditions -Prior pregnancy with fetal/infant loss -History of mental illness -Social Determinants of Health
- low monthly income, lower education levels, or unemployed status, childbearing people who are unpartnered"
"Reasons for post-adoption depression: - CORRECT ANSWER -unrealistic expectations
-difficulties bonding with the infant or child -complicated relationships with birthparents in open adoptions -underestimation of the impact that adoption would have on parents' and families' lives -question their legitimacy as a parent"
"MMHDs: Bipolar Disorder - CORRECT ANSWER -DSM-5-TR includes a specifier for bipolar
disorder with peripartum onset
- symptoms that begin during pregnancy or in the first four weeks following childbirth -childbirth can trigger hypomanic episodes
- often early in the postpartum period
- may have severe depressive episode several weeks later -Early detection of signs of hypomania is necessary to reduce suicide & infanticide risk"
"MMHDs: Anxiety Disorder - CORRECT ANSWER -Generalized anxiety disorder
- difficult to distinguish from symptoms experienced by new parents -Symptoms: irritability, difficulty sleeping, difficulty concentrating, easy fatiguability -Themes of worry:
- pregnancy and delivery complications
- instrument-assisted vaginal births or cesarean sections
- peripartum depression
- previous mental illness"
"maternal mental health disorders: Screening - CORRECT ANSWER -recommendations from
the American College of Obstetricians and Gynecologists (ACOG)
- screening at least once during the perinatal period using a validated instrument
- increasing the frequency of visits when symptoms are identified
- referring clients for appropriate pharmacotherapy & psychotherapy treatments -American Academy of Pediatrics (AAP) recommends:
- incorporating the Edinburgh Postnatal Depression Scale (EPDS) into infants' 1, 2, 4, and 6- month well check visits using a cutoff score of 10 as an indicator that maternal depression may be present"
"Edinburgh Postnatal Depression Scale (EPDS) to screen for maternal mental health disorders -
CORRECT ANSWER -questionnaire to identify women who may have postpartum depression
-A score of more than 10 suggests minor or major depression may be present
- Further evaluation is recommended https://perinatology.com/calculators/Edinburgh%20Depression%20Scale.htm" "Shawnta is a 29-year-old who delivered her first child one month ago. She has been seeing a psychiatric mental health nurse practitioner for therapy for the past two years to work on post- traumatic stress disorder following a sexual assault. She has no other psychiatric or physical health history and no family history of mental illness. Shawnta presents for a telehealth therapy visit and notes that over the past few days, she has felt more "down" than usual. Her partner
returned to work a we - CORRECT ANSWER plan to repeat the screening in two weeks at
Shawnta's next therapy appointment Rationale: Mothers who score over 13 on the EPDS are likely suffering from depressive illness; however, the EPDS only indicates how the client felt during the previous week. Therefore, a follow-up assessment in two weeks is indicated." "At Shawnta's next appointment two weeks later, she endorses increased feelings of sadness and worry, mostly surrounding the baby. Her repeat EPDS screening score is 14. Which of the following management strategies is the most appropriate next course of action for Shawnta? plan to repeat the screening in two weeks at Shawnta's next therapy appointment request that Shawnta schedule an in-person visit as soon as possible
request a joint therapy session with Shawnta's partner
discuss antid - CORRECT ANSWER discuss antidepressant medications
Rationale: Shawnta's current EPDS score of 14 indicates likely depressive disorder, which requires the PMHNP to discuss treatment options with her, which may include antidepressant medications."
"treating MMHDs: Perinatal Depression - CORRECT ANSWER -SSRIs: first-line
pharmacologic once bipolar II disorder ruled out -tricyclic antidepressants -omega-3 fatty acids may reduce depressive symptoms -brexanolone:
- new tx for postpartum depression
- IV infusion over 60 hours at certified healthcare facility
- must be enrolled in the Risk Evaluation & Mitigation Strategy Program -Nonpharmacologic:
- CBT
- interpersonal therapy
- electroconvulsive therapy for severe"
"treating MMHDs: Perinatal Bipolar Disorder - CORRECT ANSWER -Pharmacologic:
- lithium
- lamotrigine -Nonpharmacologic:
- CBT
- interpersonal therapy
- behavioral therapy
- social rhythm therapy"
"treating MMHDs: Perinatal Anxiety - CORRECT ANSWER -Pharmacologic:
- SSRIs -Nonpharmacologic:
- CBT
- interpersonal therapy"
"treating MMHDs: Perinatal Psychosis - CORRECT ANSWER -Pharmacologic:
- Can impact child's: ➣Development of a core sense of self ➣Ability to integrate experiences ➣Epigenetic expressions"
"How a caregiver's trauma can impact a child's development: Adulthood - CORRECT
ANSWER -person who had a caregiver with untreated trauma may:
- Be more prone to PTSD after trauma
- Struggle to repair after conflict
- Struggle with relationships
- Unintentionally bring out negative behaviors in others
- Be emotionally detached
- Be more prone to dissociate"
"Stigma of Maternal Mental Health Disorders - CORRECT ANSWER -may impact the
individual's sense of safety regarding sharing their negative or challenging experiences
- may fear revealing symptoms to others out of shame, guilt, or fear that their infant may be taken away from them" "___________ and ___________ have been demonstrated to have the lowest serum concentrations
among infants exposed to medication during breastfeeding - CORRECT ANSWER Bupropion
and Sertraline"
"Pediatric Anxiety & Obsessive-Compulsive Disorder (OCD) - CORRECT ANSWER -
Separation anxiety -Social anxiety -OCD -Body dysmorphic disorder"
"Anxiety - CORRECT ANSWER -Increased brain activity in the amygdala & prefrontal cortex
-PET scans have also shown reduced serotonin binding in patients with anxiety -GAD
- persistent, uncontrollable worrying that causes emotional distress, symptoms on most days, for a period of at least 6 months -Symptoms:
- worrying, restlessness, irritability, muscle tension, fatigue, sleep disturbances"
"Risk factors for developing anxiety - CORRECT ANSWER -genetic predisposition (family
history of anxiety) -being female -recent life stressors
-chronic physical illness -lack of support during childhood"
"Medications for anxiety: GAD - CORRECT ANSWER -SSRIs
-SNRIs -buspirone -Drug Therapy at least 12 months"
"Medications for anxiety: Panic Disorder - CORRECT ANSWER -paroxetine
-sertraline -fluoxetine -Drug therapy 6-9 months"
"Medications for anxiety: OCD - CORRECT ANSWER -fluoxetine
-fluvoxamine -sertraline -paroxetine -clomipramine (TCA) -Drug therapy for at least 1 year"
"Medications for anxiety: Social Anxiety Disorder - CORRECT ANSWER -sertraline
-paroxetine -Drug therapy takes 4 weeks to see effects"
"Medications for anxiety: PTSD - CORRECT ANSWER -paroxetine
-sertraline"
"Depression - CORRECT ANSWER -Decreased brain activity in the prefrontal cortex
-symptoms that last >2 weeks -Symptoms:
- depressed or irritable mood, diminished interest in activities, significant weight or appetite changes, fatigue, feelings of worthlessness, sleep disturbances, diminished ability to concentrate -can be influenced by genetic & environmental factors, stressful life events
- giving birth or experiencing emotional trauma -linked to neurotransmitter imbalances"
"MDD - CORRECT ANSWER -primary feature of MDD is the occurrence of at least 1 episode of
major depression lasting at least 2 weeks -must experience 5 or more of the following symptoms in 2 weeks to be diagnosed with a major depressive episode:
- feeling low most of the day for most days
- decreased interest in activities
- inhibit NE reuptake (↑energy)"
"Tricyclic Antidepressants (TCAs) - CORRECT ANSWER -Action:
- inhibits the reuptake of serotonin & norepinephrine
- blocks norepinephrine, histamine, & acetylcholine receptors -Ex:
- amitriptyline
- clomipramine
- desipramine
- doxepin -Common Side Effects:
- dry mouth, constipation, blurred vision, urinary retention sedation, weight gain, hypotension, tachycardia, and sexual dysfunction"
"Monoamine Oxidase Inhibitors (MAOIs) - CORRECT ANSWER -Action:
- increases norepinephrine & serotonin by inhibiting the enzyme that inactivates it -Ex:
- isocarboxazid
- phenelzine
- tranylcypromine -Common Side Effects:
- sedation, dizziness, sexual dysfunction, & hypertensive crisis"
"Bipolar disorder medications: Lithium - CORRECT ANSWER -Lithium
- Action: alters cation transport in the nerve & muscle
- Indication: euphoric mania, rapid cycling, maintenance therapy
- Adverse Effects: ➣GI effects, tremor, polyuria• Monitor plasma levels• Use to protect against suicide"
"Bipolar disorder medications: lamotrigine (Lamictal) - CORRECT ANSWER -lamotrigine
(Lamictal)
- Action: affects sodium channel ion transport & enhances the activity of y-aminobutyric acid (GABA)
- Indication: maintenance therapy, monotherapy
- Adverse Effects: ➣benign rash (risk for rare Stevens-Johnson Syndrome rash & multi-organ failure), GI effects, dizziness, h/a• equal in efficacy to lithium
- Take at bedtime due to sedation side effect"
"Bipolar disorder medications: valproic acid (Depakene) - CORRECT ANSWER -valproic acid
(Depakene)
- Action: affects ion transport and enhances the activity of y-aminobutyric acid (GABA)
- Indication: acute mania, mixed mood, comorbid substance use, multiple prior episodes
- Adverse Effects: ➣GI effects, weight gain
- equal to lithium
- Monitor plasma levels
- If using with lamotrigine decrease valporate levels by 50%"
"Bipolar disorder medications: Second generation antipsychotics - CORRECT ANSWER -
Second generation antipsychotics
- Action: DA, NE, and 5-HT receptor antagonists
- Indication: acute bipolar depression, acute manic or mixed episodes, bipolar maintenance/adjunct
- Adverse Effects: ➣weight gain, sedation, GI effects
- Monitor for extrapyramidal effects
- XR form may improve adherence
- injection may improve adherence"
"Bipolar disorder medications: carbemazepine (Tegretol) - CORRECT ANSWER -
carbemazepine (Tegretol)
- Action: glutamate voltage gated sodium & calcium channel blocker (Glu-CB
- Indication: acute mania, mixed mood
- Adverse Effects: ➣GI effects, sedation, hyponatremia, neutopenia, rash (Stevens-Johnson Syndrome)
- Monitor plasma levels
- Consider genotyping clients with Asian ancestry ➣HLA-B 2501 allele increases risk of Steven-Johnson Syndrome"
"pediatric anxiety disorders - CORRECT ANSWER -among the most diagnosed mental health
disorders
- 9.4% of U.S. children & youth (5.8 billion) -can result in:
- academic & social impairment
- persist into adulthood
- comorbid mental health problems, depression most common -Anxiety Disorders by age
- 1.3% of children aged 3-5 years
- 6.6% of children aged 6-11 years
