Answer
Question 1
The correct answer to Question 1 is C: Children who have a history of repeated, self-limited, severe tantrums require at least a 72-hour admission.
When children present to care acutely due to violent, enraged behavior, it is important for the PMHNP to assess and determine the appropriate course of action. In the case of children with a history of repeated, self-limited, severe tantrums, it is necessary to consider a 72-hour admission. This is because these tantrums may be indicative of underlying mental health issues or significant distress that require further evaluation and intervention.
While it may be tempting for the clinician to ask the child for his version of events if he appears to be calming down in the emergency area, it is important to prioritize the child’s safety and well-being. Approaching this patient under no circumstances (option A) or assuming that prepubertal children typically require medication (option B) is not supported by evidence and may not be the most appropriate course of action.
Question 2
The correct answer to Question 2 is D: Social anxiety disorder.
In the case of Phillip, a 5-year-old boy who does not speak at school, the PMHNP suspects that he may have selective mutism. Selective mutism is closely related to social anxiety disorder, characterized by an individual’s consistent failure to speak in specific social situations despite speaking in other situations. In Phillip’s case, his extreme shyness and discomfort with people making a fuss over him further support this suspicion.
Options A, B, and C (a history of sexual abuse, fetal alcohol syndrome, and early-onset schizophrenia) are not necessarily related to selective mutism and are not the most likely explanations for Phillip’s presentation.
Question 3
The correct answer to Question 3 is C: Assessment without the parents present.
When evaluating Jason, a 17-month-old male with a high level of irritability, it is important to consider various aspects of assessment. A comprehensive medical assessment (option A), standardized developmental measures (option B), and observation of Jason during play (option D) are all appropriate components of a comprehensive assessment.
However, assessing Jason without the parents present (option C) may not provide a complete picture of his behavior and potential underlying factors. Involving the parents in the assessment process is important for gathering information, understanding Jason’s context, and ensuring that the parents feel heard and included in their child’s care.
Question 4
The correct answer to Question 4 is A: Establishing a safe place for the child.
When treating abused children, a multimodal and long-term approach is necessary. While various aspects of treatment are important, establishing a safe place for the child is the single most important aspect. This involves creating an environment where the child feels secure, supported, and protected from further harm. Without a safe place, other treatment modalities may be less effective or even potentially harmful.
Exposure related to the feared experience (option B), psychoeducation (option C), and cognitive-behavioral interventions (option D) may also be important components of treatment but are secondary to establishing a safe place.
Question 5
The correct answer to Question 5 is C: 5 to 11 years.
Having child and adolescent patients rate their feelings and moods on a scale of 1–10 can be beneficial in assessing their emotional well-being and tracking changes over time. While this approach may be effective in various age groups, it is most commonly used and effective in the age group of 5 to 11 years.
Options A, B, and D (18-months to 3 years, 3 to 5 years, and 12 to 17 years) may also benefit from rating scales, but this age group is typically more capable of providing reliable and meaningful ratings of their feelings and moods.
