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NR 606 WEEK 8 FINAL EXAM 2025/2026 COMPLETE
QUESTIONS AND COMPLETE ANSWERS
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“Stimulant Medications: Methylphenidate - CORRECT ANSWER -Low risk of adverse effects
-Available formulations:
- Ritalin - available in immediate release (IR) and extended release (XR) available in beads that may be sprinkled on food for children who cannot swallow pills
- Concerta biphasic - combined immediate and delayed release in one medication
- Daytrana - patch applied in AM and removed after 9 hour"
"Stimulant Medications: Dexmethylphenidate (Focalin) - CORRECT ANSWER -Available in
IR and ER -More potent than Ritalin -High risk of adverse effects"
"Stimulant Medications: Amphetamine (Adzenys) - CORRECT ANSWER -available in orally
disintegrating ER formula for children who cannot swallow pills -Avoid prescribing when an MAOI has been used within 14 days"
"Stimulant Medications: Dextroamphetamine (Adderall) - CORRECT ANSWER -Available in
IR and extended-release formulations -Often dosed in morning (IR or XR) with an evening or evening prn (IR) dose if med effects diminish prior to end of school, study or the workday -Most abused & diverted prescription stimulant"
"Stimulant Medications: Lisdexamfetamine (Vyvanse) - CORRECT ANSWER -Biologically
inactive until metabolized by the body (Prodrug) -Less abuse & diversion potential than other stimulants -Higher-cost medication"
"Non-stimulant medication: Atomoxetine (Strattera) - CORRECT ANSWER -Noradrenergic
(NRI)
-Initial drug of choice for adults with ADHD -no abuse potential -tolerated well when prescribed in BID dosing -appropriate choice for comorbid substance abuse -may augment the effects of antidepressants & antianxiety meds
-can be dosed at bedtime if fatigue is noted -unlikely to worsen tics"
"Non-stimulant medication: Clonidine - CORRECT ANSWER - α2 agonist
- May be taken as monotherapy or with stimulant medications -enhances precortical function for better mental focus -appetite neutral -may help with sleep disturbances, administer at bedtime -adverse effects:
- sedation, brain fog -monitor of BP closely during initial titration, risk of hypotension -tapered to avoid rebound hypertension post discontinuation"
"Non-stimulant medication: guanfacine - CORRECT ANSWER - α2 agonist
- May be taken as monotherapy or with stimulant medications -may also be used for children with tics, sleep disturbances, or aggression -tolerability & convenience enhanced by once-daily oral controlled-release formulation -adverse effects:
- sedation, headache, decreased appetite -reduced side-effect profile comparable to clonidine -bedtime administration to avoid daytime sedation"
"Non-stimulant medication: Bupropion (Wellbutrin) - CORRECT ANSWER -Norepinephrine
Dopamine Reuptake Inhibitor -off-label use for ADHD in adults -appropriate for clients with concurrent depression or tobacco abuse"
"Rating scales for ADHD - CORRECT ANSWER -ADHD Rating Scales (ADHD-RS-IV and 5)
-Swanson, Nolan and Pelham (SNAP) scale -Adult ADHD Self Report Scale (ASRS) -Vanderbilt scales -Conners' scales"
"ADHD Comorbidities - CORRECT ANSWER >2/3 of children dx'd with ADHD have at least
one coexisting psychiatric condition -learning disabilities -conduct disorders -tics -anxiety -depression -language disorders -SUD's
"Addison is a 9-year-old who was diagnosed with ADHD predominantly combined presentation and was prescribed methylphenidate extended-release chewable tablets 20 mg once daily. Since she has started taking the medication, her appetite has decreased. She is 51 inches tall, and her initial weight was 58 lbs. She has lost 8 lbs. since beginning treatment. Which of the following medication adjustments is appropriate for Addison? implement stimulant holidays on weekends and non-school days decrease the dosage of methylphenidate extended-release to 10 mg daily switch to methylphenidate immediate-release 20 mg once daily
switch to atomoxetine 25 mg once daily - CORRECT ANSWER implement stimulant holidays
on weekends and non-school days Rationale: Stimulant holidays combined with caloric supplementation and monitoring can help offset stimulant-related weight loss. Switching to a non-stimulant medication may be warranted if drug holidays do not provide the desired result of weight stabilization."
"ADHD nonpharmacologic tx - CORRECT ANSWER -Schools
- educational support, behavioral interventions in the classroom, and accommodations -Psychotherapy
- CBT
- social and organizational skill training
- family therapy.
- Under age 6 ➣American Academy of Pediatrics (AAP) recommends parent training in behavior management as a first-line intervention"
"ADHD parent training in behavior management - CORRECT ANSWER -What parents learn:
- Positive Communication
- Positive Reinforcement
- Structure and Discipline"
"ADHD complementary and alternative medicine (CAM) interventions - CORRECT ANSWER
-dietary approaches -nutritional supplements -mind/body practices
-brain training programs"
"disruptive behavioral disorders - CORRECT ANSWER -Disruptive, impulse-control, &
conduct disorders -problems with emotional & behavioral regulation -often violate others' rights -bring ind. into conflict with social norms & authority figures -Behaviors often severe, frequent, occur in varied settings, can have serious consequences -more common in boys than girls -first onset in childhood or adolescence -Common diagnosis:
- oppositional defiant disorder
- conduct disorder
- intermittent explosive disorder"
"Conduct Disorder subtypes - CORRECT ANSWER -based on the age at onset:
- childhood-onset ➣symptoms before age 10
- adolescent-onset ➣symptoms after age 10
- unspecified-onset subtype when the age at onset is unknown."
"Conduct disorder pharmacologic tx - CORRECT ANSWER -atypical antipsychotics
-SSRIs -Mood stabilizers -Beta blockers *Main component of tx is psychotherapy"
"Intermittent explosive disorder (IED) - CORRECT ANSWER -low tolerance for frustration &
adversity -essential features: freq impulsive or angry outbursts, often include temper tantrums, verbal assaults, or physical assaults towards others, animals, or property
- unplanned
- rapid onset
- out of proportion to the trigger that elicited the response
- lasts no longer than 30 minutes -Verbal outbursts: average of twice a week for three months -behavioral outbursts or tantrums that involve the destruction of property within 12 months -outbursts often lead to subjective distress or social or occupational dysfunction and poor life satisfaction and quality of life for the affected individuals."
"disruptive, impulse-control, and conduct disorders assessment and screening - CORRECT
ANSWER -comprehensive psychiatric evaluation
- family hx
- parenting styles
- developmental hx
- academic records -child-rated, caregiver-rated, and clinician-rated tools
- Minnesota Impulse Disorders Interview (MIDI) ➣diagnostically valuable" "federal law designed to ensure that children who have disabilities receive free appropriate
public education (FAPE) - CORRECT ANSWER the Individuals with Disabilities Education
Act (IDEA) -Initially passed in 1975 -IDEA ensures that:
- Children with an identified disability receive individualized special education & services that address their needs.
- Children with disabilities receive preparation for employment & independent living.
- Children & families impacted by disability are protected under the law.
- Federal agencies, states, localities, & educational service agencies that provide educational assistance to children with disabilities receive support." "protects the rights of individuals with disabilities who are enrolled in programs receiving
federal financial assistance through the U.S. Department of Education - CORRECT ANSWER
Section 504 of the Rehabilitation Act of 1973 -Support typically provided through implementation of Individualized Education Plans (IEP) or 504 plans
- describe the services & accommodations that will be provided to students with qualifying disabilities"
"Types of Feeding and Eating Disorders - CORRECT ANSWER -Anorexia nervosa
-Bulimia nervosa -Binge eating disorder -Pica -avoidant/restrictive food intake disorder (ARFID)" "With repeated ingestion of a drug, the drug shows decreased effect. Increasing doses are
required to achieve the effects noted with the original administration. - CORRECT ANSWER
Tolerance"
"State of adaptation produced with repeated administration of certain drugs so that physical
symptoms occur when the drug is discontinued abruptly. - CORRECT ANSWER Dependence"
"A change in behavior caused by biochemical changes in the brain after continued substance use characterized by preoccupation with and repeated use of a substance despite of negative
outcomes. - CORRECT ANSWER Addiction"
"Physiological and psychological reactions that occur when the use of a substance is stopped
abruptly. - CORRECT ANSWER Withdrawal"
"Condition following the ingestion of a substance resulting in changes in level of consciousness,
cognition, perception, judgment, and behavior. - CORRECT ANSWER Intoxication"
"Feeding and Eating Disorders Background - CORRECT ANSWER -severe, persistent
disturbances in eating behaviors -approx. 9% of pop. in U.S.
- costing $64.7 billion per year -second deadliest mental health condition, after opioid overdoses
- approx. 10,200 deaths per year -typically develop in adolescence or young adulthood -more common in women -serious physical effects, contribute to psychological distress, disruptions in social functioning"
"anorexia nervosa Dermatologic Cutaneous manifestations: - CORRECT ANSWER -Xerosis
(dry, scaly skin) -Lanugo-like body hair (fine, downy, dark hair) -Telogen effluvium (hair loss) -Carotenoderma (yellowing) -Acne -Hyperpigmentation -Seborrheic dermatitis (erythema and greasy scales) -Acrocyanosis (cold, blue, and occasionally sweaty hands or feet) -Perniosis (painful or pruritic erythema)
- Petechiae -Livedo reticularis (reddish-cyanotic circular patches) -Paronychia (inflamed lateral and posterior nail folds) -Pruritus -Striae distensae (erythematous or hypopigmented linear patches) -Slower wound healing"
Rationale: Anorexia nervosa is an eating disorder where the main features include a refusal to maintain minimal body weight, a pathological fear of gaining weight, and a distorted body image in which sufferers continue to insist they are overweight." "Which of the following symptoms is consistent with anorexia nervosa binge-eating/purging type? avoiding eating to help control weight gain not being bothered about weight gain regularly using laxatives
eating only certain types of foods - CORRECT ANSWER regularly using laxatives
Rationale: Binge eating/purging type anorexia nervosa is a type of eating disorder that involves regularly engaging in purging activities, such as vomiting or the misuse of laxatives, diuretics, or enemas, to help control weight gain." "Aniyah is a 7-year-old who presents to the emergency department with complaints of abdominal pain. Her mother endorses a reduced appetite over the past three days, and she has not had a bowel movement in five days. Aniyah has no past medical history. She lives with her mother and older brother; her parents are separated, and her father moved out two months ago. Aniyah is in second grade; her developmental progress is age-appropriate. The medical team completed an assessment including an abdominal x-ray, which shows multiple rectangular radiopaque foreign bodies in the large intestine. After the x-ray was completed, Aniyah admitted to eating pencil erasers daily for the past two months. Which of the following is the most appropriate ICD-10-CM for Aniyah? F98. F50. F50.
F32.9 - CORRECT ANSWER F98.
Rationale: Aniyah meets the diagnostic criteria for pica: persistent eating of nonfood substances for at least a month, inappropriate to developmental level, and not a part of a culturally supported practice. The ICD-10-CM code for pica in children is F98.3 and for adults is F50.8." "Nichole is a 17-year-old who is 29 weeks pregnant with her first child. She has no past medical or psychiatric history. She was referred to the PMHNP (Psychiatric Mental Health Nurse Practitioner) by her obstetrician (OB) after she admitted to cravings for and consumption of paper on a regular basis. Nichole's OB ordered a complete blood count (CBC), comprehensive metabolic profile (CMP), and glucose tolerance test, all of which were normal. Nichole complains of mild heartburn and occasional constipation which she has been treating with over-the- counter antacids and laxatives. Nichole endorses eating about 3-4 sheets of copy paper each day,
typically during her restroom breaks at school. She has been doing so for the past 8-10 weeks. She has not discussed this behavior with anyone other than her OB; she states that she finds the
behavior "a bit weird and embarrassing." She states that other than eating paper, s - CORRECT
ANSWER no
Rationale: Although Nichole believes her behavior is "weird and embarrassing," she does not meet the diagnostic criteria for pica. Although she has been consuming nonfood substances for over a month, her behavior is occurring in the context of her pregnancy and the ingestion of paper does not pose potential medical risks."
"Screening for Eating Disorders: SCOFF tool - CORRECT ANSWER -five-item measure
- Do you make yourself SICK because you feel uncomfortably full?
- Do you worry you have lost CONTROL over how much you eat?
- Have you recently lost more than ONE stone (14 pounds or 6.35 kg) in three months?
- Do you believe yourself to be FAT when others say you are too thin?
- Would you say that FOOD dominates your life?"
"Screening for Eating Disorders: PARDI - CORRECT ANSWER The Pica, ARFID, and
Rumination Disorder Interview (PARDI) -clinical assessment tool -designed to assess & diagnose pica & ARFID -PARDI Parent/Carer 2-3 and Parent/Carer 4+
- modified for use with children and their caregivers -PARDI Self 8-13 and Self 14+
- used with adolescents -preliminary support for validity and reliability"
"Anorexia Nervosa Tx - CORRECT ANSWER -multidisciplinary
- psychotherapy & pharmacological interventions -Tx goals
- restoration of sufficient nutrition
- return to a healthy weight
- reduction of excessive exercise
- elimination of binge-purge & binge-eating behaviors
- primary goal in medically stable AN pt is weight gain -Psychotherapy is essential -family therapy & CBT are effective modalities, can be implemented with tx manuals specific to anorexia nervosa -Medications can help address comorbid psychopathologies:
- depressive disorders, anxiety disorders, OCDs -Psychotherapy
"Pica Tx - CORRECT ANSWER -no gold standard tx
-primarily behavioral tx's
- noncontingent reinforcement, environmental enrichment, and overcorrection -Pharmacological interventions, typically not used, only address co-morbid conditions -surgical interventions when obstructions or perforations occur -No interventions proven efficacious for long-term tx"
"ARFID Tx - CORRECT ANSWER -limited literature about tx & no med is specifically
indicated for use in this disorder -once medically stable
- family-based therapy adapted specifically for clients with ARFID has demonstrated effectiveness"
"Gender identity - CORRECT ANSWER One's concept of oneself as male, female, a blend of
both, or neither derived from an interaction of biological traits, developmental influences, & environmental conditions. -Transgender -Nonbinary -Cisgender -Agender"
"Gender expression - CORRECT ANSWER -external appearance or performance of one's
gender. -may include clothing, behavior, other characteristics. -may be associated with masculine traits, feminine traits, both, or neither -may or may not conform to socially defined gender behaviors -does not necessarily reflect gender identity.
- Feminine
- Masculine
- Androgynous
- Gender-neutral
- Gender non-conforming"
"Sexual orientation - CORRECT ANSWER -Enduring emotional, romantic, or sexual
attraction to others
- Heterosexual/straight
- Homosexual/gay/lesbian
- Bisexual
- Pansexual
"Assigned sex - CORRECT ANSWER -Sex assigned to an infant at birth
-based on visible sex organs & other physical characteristics
- Male
- Female
- Intersex" "Children begin to become aware of the physical differences between boys and girls at
approximately __________ of age - CORRECT ANSWER 2 years of age
-By 4 most have an established gender identity"
"Diagnosing Gender Dysphoria - CORRECT ANSWER -when a person experiences clinically
significant discomfort or distress from the misalignment of their gender identity & their assigned sex -often begin in childhood
- may not experience symptoms until puberty or later -Dx criteria different for adolescents & adults -All ages: must experience significant distress or impairment in social, occupational, or other areas of functioning as a result of symptoms -dx typically req to receive gender-affirming care, including hormone therapy or surgical intervention"
"consequences frequently experienced by transgender persons - CORRECT ANSWER -80%
trans students feel unsafe at school because of their gender expression -58.7% of gender non-conforming students have experienced verbal harassment in the past year because of their gender expression
- compared to 29% of their peers -49% of trans ppl reported physical abuse (2007 survey) -50% of trans ppl have been raped or assaulted by a romantic partner -Trans people of color are 6x more likely to experience physical violence when interacting with police than white cisgender survivors of violence -41% of trans ppl have attempted suicide -1/5 trans ppl have experienced homelessness at some point -1/8 have been evicted due to being trans"
"Treatment for clients with gender dysphoria - CORRECT ANSWER -highly individualized
-supportive care environment that allows for the exploration of gender identity & expression is essential -Gender-Affirming Psychotherapy -Parental & Sibling coaching -Individual therapy"
- both chosen name & legal name on assessment forms, blank space for gender
- spaces in EMR & paper forms to allow pts to identify appropriately -pediatric pt, have boxes for "Parent 1 & Parent 2" instead of "mother" & "father". -non-gendered bathrooms -educational materials with health information relevant to LGBTQ+ clients -posters that display racial, ethnic, and sexual diversity -provider and staff training"
"Substance Use Disorders in Adolescents - CORRECT ANSWER -Substance use often begins
in adolescence
- when 1st signs of other mental illnesses commonly appear -Much of brain development occurs in adolescence -Executive functioning & impulse control tend to occur in late adolescence-early adulthood
- vulnerable to substance use & development of a SUD -By adulthood, 50% have tried illicit substance, >80% used alcohol -alcohol, marijuana, tobacco are substances adolescents used most freq."
"Annual Prevalence of Use of Various Drugs for Grades, 8, 10, and 12 Combined: - CORRECT
ANSWER 38.3% will use alcohol
24.6% will use marijuana 27.1% will vape or smoke cigarettes 9.2% will use illicit drugs other than marijuana"
"Diagnosing SUDs in Adolescents - CORRECT ANSWER -recurrent use of a substance, such as
alcohol or drugs, causes clinically significant impairment
- health problems, disability, or failure to meet responsibilities at home, work, or school -not all who experiment with substances will meet criteria SUD -adolescents may experience (-) social & health consequences
- can affect growth & development of the brain & increase freq of risky behaviors"
"Early drug use is a risk factor for: - CORRECT ANSWER later development of a SUD & other
mental health conditions"
"SUDs Common Comorbidities - CORRECT ANSWER -other mental health conditions
- Anxiety disorders
- Depression
- Bipolar disorder
- Psychotic illness
- Borderline personality disorder
- Antisocial personality disorder"
"Individuals with untreated _______ are at particular risk for developing a SUD - CORRECT
ANSWER ADHD"
"Adolescent substance use Screening - CORRECT ANSWER -American Academy of Pediatrics
(AAP) recommended universally screening all adolescents for substance use during routine healthcare visits
- using a Substance Use Screening, Brief Intervention, & Referral (SBIRT) approach -commonly used SBIRT tool is the CRAFFT screening tool
- recommended by the AAP Bright Futures Guidelines for preventative care screenings."
"CRAFFT tool - CORRECT ANSWER • C: Have you ever ridden in a Car driven by someone,
including yourself, who was "high" or had been using alcohol or drugs
- R: Do you ever use alcohol or drugs to Relax, feel better about yourself or fit in?
- A: Do you ever use alcohol or drugs while you are by yourself (Alone)?
- F: Do you ever Forget things that you did while using alcohol or drugs?
- F: Do your Family or Friends ever tell you that you should cut down on your drinking or drug use?
- T: Have you ever gotten into Trouble while you were using alcohol or drugs? *2+ yes answers suggest a significant problem"
"SUD screening tools to use with adolescents 12-18 years - CORRECT ANSWER -Screening to
Brief Intervention (S2BI) -Brief Screener for Tobacco, Alcohol, and other drugs (BSTAD)"
"Drug testing - CORRECT ANSWER -AAP supports the use of drug testing in:
- emergencies
- on a voluntary basis as part of a full assessment of behavioral or mental health symptoms
- as part of therapy or monitoring of a client with an identified substance use disorder -the use of "suspicionless" drug testing as a means of screening for drug use is not useful for both practical & ethical reasons -parents may request that a provider drug test their child
- AAP cautions against the use of involuntary drug testing on a mentally competent adolescent"
"AAPs position on drug testing at home and in schools - CORRECT ANSWER video"
"Adolescent SUDs Tx - CORRECT ANSWER -Behavioral treatments
- most prevalent interventions for adolescent SUDs
- CBT, group therapy, contingency management, motivational interviewing -12-step programs or peer-to-peer programs -Residential treatment
- parasympathic nervous system is dominant.
- Decreased heart rate/BP/temp.
- pt may not be able to speak at all.
- Blank stare.
- Sensory info stops at the thalamus. It doesn't reach the cortex. pt less aware of their internal & external world.
- Endorphins release to numb pain. Dynorphins release, which can make the client feel detached from their body.
- Can result in fainting."
"How Trauma Impacts Four Different Types of Memory: Semantic Memory - CORRECT
ANSWER -What it is: memory of general knowledge & facts.
-Explicit Memory -Example: You remember what a bicycle is. -How trauma can affect it: Trauma can prevent info (like words, images, sounds, etc.) from different parts of the brain from combining to make a semantic memory. -Related brain area: The temporal lobe and inferior parietal cortex collect information from different brain areas to create semantic memory."
"How Trauma Impacts Four Different Types of Memory: Episodic Memory - CORRECT
ANSWER -What it is: The autobiographical memory of an event of experience - including the
who, what, and where. -Explicit Memory -Example: You remember who was there and what street you were on when you fell off your bicycle in front of a crowd. -How trauma can affect it: Trauma can shutdown episodic memory and fragment the sequence of events. -Related brain area: The hippocampus is responsible for creating and recalling episodic memory."
"How Trauma Impacts Four Different Types of Memory: Emotional Memory - CORRECT
ANSWER -What it is: The memory of the emotion you felt during an experience.
-Implicit Memory -Example: When a wave of shame or anxiety grabs you the next time you see your bicycle after the big fall. -How trauma can affect it: After trauma, a person may get triggered and experience painful emotions, often without context. -Related brain area: The amygdala plays a key role in supporting memory for emotionally charged experiences."
"How Trauma Impacts Four Different Types of Memory: Procedural Memory - CORRECT
ANSWER -What it is: The memory of how to perform a common task without activtely thinking
about it. -Implicit Memory -Example: You can ride a bicycle automatically without having to stop and recall how it's done. -How trauma can affect it: Trauma can change patterns of procedural memory. For example, a person might tense up and unconsciously alter their posture, which could lead to pain or even numbness. -Related brain area: The striatum is associated with producing procedural memory and creating new habits."
"Four Key Ways Collapse/Submit response to trauma Can Present in a Client. - CORRECT
ANSWER 1. Compliance / Obedience:
-going through the motions of life on autopilot -feel detached from bodily experiences -feelings no longer guide their actions
- Ex: domestic violence pt may no longer be aware of fear, which keeps the person in the situation.
- Treatment-Resistant Depression: -ongoing, inescapable traumatic stress can lead to treatment-resistant depression.
- defining feature: learned helplessness.
- Interpersonal Conflict: -difficulty engaging with others &/or setting boundaries.
- Social Avoidance / Desire to Isolate: C -difficult to engage in basic daily activities
- making meals or personal hygiene -may withdraw socially."
"Brain-based approaches to help clients after trauma - CORRECT ANSWER -Top-down
approaches
- Encourage different ways of thinking
- Cognitive-Behavioral Therapy (CBT)
- Dialectical-Behavior Therapy (DBT)
- Mindfulness-based Cognitive Therapy (MBCT) -Bottom-up approaches
- Ways to cope with emotions and defenses
- Eye Movement Desensitization and Reprocessing (EMDR)
- Yoga
