WEEK 6 FORUM

  

This week, we have discussed issues related to gender and sexuality. You should have some idea of the ways that both biology and society shape our expectations and views of both males and females. Sometimes, however, the issue is not so clear-cut. If you are not familiar with the terms “hermaphrodite” or “intersex,” I suggest that you look them up before participating in this week’s discussion. Then link to and read the following account:
 

www.slate.com/id/2101678/
 

This is obviously a very tragic case on many levels.
 

1.) What does this case tell you about the power of biology?
 

2.) Does it support or refute Dr. Money’s (and others’) apparent view that children are a “blank slate,” and that they can successfully transition from one sex to another if it is done early enough in childhood?
 

3.) Given what happened to David Reimer, what would be your opinion now on whether “sex reassignment surgery” should be done on infants or young children who are born with an intersex condition? Support your argument with empirical research findings. 

READING

Introduction

This lesson will cover peer interactions, friendship and gender. We will begin by exploring how peer interactions develop, and what peer acceptance means in the context of child development. We will investigate how social information-processing functions in popular and unpopular children, and the impact of this on children’s short- and long-term development. We will then move onto friendship, where we will look at what friendship means in the different stages of development. We will look at how groups function, and the importance of teenage romances. We will also look at gender, and the impact of gender stereotypes in child development. We will discuss the role of biology, cognition, family and other social influences on the genders. Lastly, we will have a brief discussion about sexual orientation and androgyny.

Development of Peer Interactions

‹ 1/4 ›

· Early Social Experiences

As we have discussed throughout this course, the home environment has an enormous effect of child development. However, interactions outside the home influence also child development, and the ability to socialize successfully is a cornerstone of development. As the prevalence of preschool education increases, and as more mothers are employed outside the home, children’s ability to socialize at a younger age becomes more significant because of the profound impact social interactions have on a child’s self-esteem. Children’s early social experiences set the foundation for future interactions.

Peer Acceptance

Reinforcement

Children reinforce each other’s behaviors, by ignoring, paying attention to, sharing with, praising and criticizing each other. This ‘peer pressure’ begins from around the age of four, and becomes increasingly powerful as children develop, because being accepted, approved of or ostracized by peers has a tremendous impact on children’s self-esteem.

Social Comparison

Children measure themselves against other children through social comparison, in order to objectively rate and evaluate themselves. How a child is received by peers is highly related to the child’s self-esteem, and defines children’s self-image (Harter, 2006). Positive first experiences can lay the foundation for healthy social behaviors that continue into adulthood.

Sociometric Techniques

Researchers study peer acceptance by measuring each child’s status within peer groups, using sociometric techniques. These measures get the group members to rate each other in characteristics such as aggression, helpfulness and likability (Ladd, 2005).

Popularity

Sociometric techniques have enabled researchers to categorize children’s popularity based on their characteristics and styles of interaction (Bierman, Smoot, & Aumiller, 1993; French, 1990; Ladd, 2005; Parkhurst & Asher, 1992). The nominative technique is a kind of sociometric technique that gets children to select or nominate peers they most like and dislike.

● Popular children receive the most nominations for being well liked, and are prosocial, friendly, good communicators and assertive. However, some popular children have different characteristics. These include being dominant, aggressive, cool, athletic, influential and arrogant.
● Average children do not receive nominations for being well liked or disliked.
● Controversial children receive nominations from being both well liked and disliked.
● Rejected children receive many nominations for being disliked. Aggressive rejected children have behavior problems and little self-control. Nonaggressive rejected children lack social skills, and are withdrawn and anxious.
● Neglected children receive few votes as they are normally friendless and isolated.
We will now look at what drives peers’ judgements of one another.

Social Information-Processing

‹›

· SOCIAL AND COGNITIVE SKILLS

Social and cognitive skills enable children to approach and initiate new social interactions. Socially skilled children want to interact with others. For this to be possible, children need to feel comfortable with others, and this is based on the confidence that they have something useful or valuable to contribute, as well as being interested in finding out about others.

Appearances

Beauty Perceived as Virtue

Although social skills primarily determine children’s social status, there are lesser factors that may contribute. Children and teenagers attribute positive qualities, such as being fearless, friendly, self-sufficient, interpersonally competent and appealing, to people with attractive physical appearances, and attribute negative qualities, such as being aggressive, mean and antisocial, to people with unattractive physical appearances (Hawley, Johnson, Mize, & McNamara, 2007).

Physical Appearance and Treatment

Physically attractive people are treated better, judged more positively and are more popular than unattractive people, and were found to be better adjusted and to have greater intelligence (Langlois et al., 2000). Considering this research in the context of our discussions in previous lessons about the impact of stress, self-esteem and environment factors on cognitive performance, do you think it is possible that an individual’s cognitive performance could be impacted by the way they are treated because of their physical appearance?

Popular Names

Children’s names also have an impact on their social interactions (Rubin, Bukowski, & Parker, 2006). Children with popular names are more acceptable, while children with ‘funny’ names may be less acceptable to their peers. Furthermore, U.S. children generally do not play with children outside their age group, while children from other cultures, such as Africa and Asia, tend to play with children from a far wider range of age groups.

Being Unpopular

 Children can be cruel to those they dislike. Children may exclude, ignore, verbally and physically attack, harass, bully, tease, gossip about and dominate others. Sadly, many rejected children, particularly the nonaggressive ones, are victims of these behaviors.
Unpopular children experience long- and short-term consequences. These include loneliness, social dissatisfaction, alienation and isolation. Academic performance is affected, and these children may avoid or drop out of school. They may be uncooperative and begin to engage in criminal activity. Victimized children may develop depression in early adulthood and be prone to harassment at work. Rejected children usually maintain this status over their lifetime (Coie & Dodge, 1983).

Parents, Teachers, and Peer Acceptance

ATTACHMENT TO PARENTS

ROLE OF ADULTS

SOCIAL COACHING

PROVIDING PLAY OPPORTUNITIES

Watch this video on teaching children social skills at school:

Knowledge Check

1

Question 1

Please select the two correct statements. The most effective ways for adults to help children gain the acceptance of their peers are:

  

To   ensure children have positive social experiences from a young age, especially   within the family.

 

To   train and coach parents and children on social skills.

 

To   ensure the children have the best clothes and toys, and always look great.

 

Peer   acceptance is not that important, therefore adults should not get involved.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Friendship

Hartup (1996) describes friendship as a relationship between equals that includes commitment and reciprocity. Bigelow (1977) and Bigelow and LaGaipa (1975) describe how children’s expectations of friendship progress in three stages. (Please note that the italicized expectations from each stage are carried over to the next stage.)

Friendship tends to develop on the basis of communication, exchanges of information, positive exchanges, common ground, self-disclosure and effective conflict resolution (Parker & Gottman, 1989). Children display more positive affect in interactions with friends, but also disagree more with each other than with nonfriends. Conflicts between friends are usually less heated than with nonfriends, and friends generally try to resolve the conflict in a way that preserves the relationship. While a certain level of conflict in friendship is normal, certain friendships can degenerate into mutual antipathy.

REWARD-COST STAGE

NORMATIVE STAGE

EMPATHETIC STAGE

OLDER CHILDREN

Developmental Stages of Friendship

The goals and processes of friendship change with age.

· PLAY

· PEER ACCEPTANCE

· SELF-UNDERSTANDING

According to Parker and Gottman (1989), until the age of seven, the goal of peer interaction is play, and the processes are geared to facilitate successful play.

Making Friends with or without Keeping Them

An interesting study by Parker and Seal (1996) found that children who make friends easily but do not sustain friendships, know the latest gossip, are ‘playful teasers’, but are also more aggressive, bossy and untrustworthy. However, children who make new friends and sustain friendships are not bossy but are also not pushed around easily.

Intimacy with Few, Isolation from Many

Equally interesting is that the more intimate girl’s friendships are and the more isolated they are from a larger group of friends, the more fragile their relationship is (Benenson & Christakos, 2003). It appears that friendships that are embedded in larger groups may be less fragile because there is more access to alternative partners, allies and third-party mediators. Excessive ‘co-rumination’ between intimate female friends about problems is associated with depression and anxiety, and may intensify problems especially if friends divulge information about their friends to others (Rose, 2002). Boys tend to co-ruminate less, divulge less about their friends to others, and confront their friends directly when there are relationship problems (Rose & Rudolph, 2006).

Benefits of Friendship

Friendship protects against loneliness and depression by providing guidance, support and intimacy. Children with friends have better long-term outcomes. However, some friendships pose risks. Rejected and aggressive children may befriend each other, which often results in unsympathetic, conflictual relationships, as well as deviant behaviors like substance abuse, cheating and aggression (Bagwell, 2004; Poulin, Dishion, & Haas, 1999).

Groups

Dominance Hierarchy

Being part of a group is associated with increased well-being and healthier stress management. Groups always have a dominance hierarchy, which is evident in children as young as two (Hawley & Little, 1999). Hierarchy is established within the first 45 minutes of contact (Pettit, Bakshi, Dodge, & Coie, 1990). Hierarchy promotes social organization and regulation, whereby nonaggressive conflict resolution is orchestrated by higher ranking members, tasks are divided and lower ranking members are allocated working roles and higher ranking members assume leadership roles, and resources are allocated.

Culture

Culture plays a role in the characteristics of peer groups. For example, Israeli children in rural kibbutzim are found to be more cooperative than children from cities, African American children have more opposite-gender friendships, Japanese and Latino children are more family oriented, and Italian children engage in more disputes and debates with friends but have more stable friendships – perhaps due to the higher tolerance for conflict (Casiglia, Lo Coco, & Zappulla, 1998; deRosier & Kupersmidt, 1991; Kovacs, Parker, & Hoffman, 1996; Schneider, 2000). Chinese children form more cliques based on academic achievement (Chen, et al., 2003).

Romance

Adolescent romance is an important developmental milestone. Nurturant parenting is associated with better quality romantic relationships, while inadequate parenting is associated with more violent, aggressive and destructive romances. We will now briefly highlight three common myths about teenage love affairs, as outlined by Parke and Gauvain (2009).

Click on the buttons below to find the reality:

MYTH 1: THESE RELATIONSHIPS ARE TEMPORARY.

MYTH 2: THESE RELATIONSHIPS ARE INCONSEQUENTIAL.

MYTH 3: ADOLESCENT ROMANTIC RELATIONSHIPS ARE INDICATIVE OF PROBLEM BEHAVIORS.

As adolescents get older, the importance of peer-approval of romantic partners decreases, while the importance of shared values and interests, interdependence, compatibility and personality increase.

Knowledge Check

1

Question 1

Please select the two most accurate depictions of how social relationships develop in children and adolescents.

  

Younger   children have more friends of the same-sex. Adolescents begin to associate   more with members of the opposite sex and have romances.

 

Younger   children start at the bottom of the group hierarchy and as they age, they   work their way up to being dominant group members.

 

The   focus changes from play, to social acceptance, to self-understanding.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Gender

There are obvious differences associated with males and females, including genetics, hormones, tendencies, behaviors including reproduction, appearance, roles, the way they are treated and expectations placed on them. However, there are also many similarities between the genders.

· GENDER TYPING

· GENDER IDENTITY

Children learn to differentiate which behaviors, values and motivations are attributed to males and females in a process called gender typing. Gender typing is based on gender stereotypes which tell us what is expected of and acceptable for each gender. Parents and other people act as agents of gender socializing.

As you watch this video on gender stereotyping, assess how children may be influenced to develop academically and intellectually based on gender typing.

Gender Stereotypes

Gender Roles Similar Worldwide

On the whole, cultures across the globe are consistent with the roles they allocate to each gender. Men are typically expected to be assertive, dominant and competitive, and women are expected to be more passive, sensitive, loving and sociable. While not always helpful in promoting gender equality, these stereotypes have generally tended to stick.

Play Preferences

For instance, research on one-year olds found that girls show preferences for dolls, while boys show preferences for vehicles (Serbin, Poulin-Dubois, Colburne, Sen & Eichstedt, 2001). Moreover, while college educated women are more likely to be advocates of female independence and achievement, men – even well-educated ones, maintain stereotyped gender-role standards, especially of their children.

Stereotypes

Why is this? The male role, particularly in Western culture, is esteemed with greater status and privileges, but is also more clearly defined, thus pressuring males into conforming to certain roles and behaviors. It is thought-provoking to note that it is normally more acceptable for girls to partake in masculine activities, and that when boys partake in feminine activities they are often ridiculed for being ‘sissies’. How do you think this relates to masculinity being ascribed a higher status that femininity?

Interests and Culture

If children’s interests are consistent with cultural standards on what is gender-appropriate, these interests tend to continue into adulthood, however, if they are not consistent, these interests rarely continue into adulthood. Moreover, Cherney and London (2006) found that boys generally develop more intense interests in gender stereotyped activities and events than girls, that last longer in the male lifespan that females’ gender stereotyped interests last.

Tendency to Follow Stereotype

While children, especially girls, may participate to a degree in both male and female pursuits, in adolescence they tend to adhere more strictly to gender stereotypes, perhaps due to increased pressure from peers, parents, other social influencers and their interest in romantic relationships (Burn, O’Neil, & Nederend, 1996). When adults become parents, gender roles also tend to become more defined, where females display expressive characteristics, such as empathy and nurturing the child, while males display more instrumental characteristics, by focusing on occupation and tasks (Cowan & Cowan, 2000).

Knowledge Check

1

Question 1

Please select the correct statement.

  

Children’s   interests and academic path have nothing to do with gender stereotyping.

 

Typical   masculine gender roles emanate from their expressive characteristics.

 

Children   chose their toys based on their gender-role preferences.

 

Gender   typing describes the types of things that are acceptable for each gender.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Biological Differences

· HORMONES

· BRAIN LATERALIZATION

· COGNITIVE FACTORS

Hormones are chemical substances that regulate certain organs, characteristics and functions. As we discussed in the second lesson, the male’s principal hormone is testosterone, and the female’s principal hormones are estrogen and progesterone. These hormones organize the fetus’s biological and psychological predispositions.

There are differences in the genders’ verbal and spatial abilities from a young age, which Hines (2004) attributes to prenatal hormones. For instance, higher androgen (male hormone) levels are associated with better visual-spatial skills. Research has also determined that when girls have more testosterone, they acquire masculine characteristics like being more assertive and enjoying rough physical play (Reiner & Gearhart, 2004).

Family Influences

Parental Influence on Gender-typing

Parents influence their children’s gender-typing and gender-role behaviors by the way they speak to them, treat them, dress them, play with them, the kinds of activities, toys, interactions and opportunities they provide, and by their modeling. From the time children are born, parents focus on their son’s alertness, size, coordination and strength, and on their daughter’s beauty, gentleness and fragility (Stern & Karraker, 1989). Parents play more with their sons, engage more in rough-and-tumble, touch them more, and speak to them in a ‘macho’ way. Boys are encouraged to be independent, and to explore, compete and achieve more (Ruble, Martin, & Berenbaum, 2006).

Sons and Daughters are Treated Differently

Parents teach sons more, but focus more on emotions and interpersonal interactions with daughters (Block, 1983). Parents cuddle girls more, talk to them more, use directive, supportive speech, and are more protective over them (Leaper & Friedman, 2007). They also encourage daughters to be more dependent. Psychologists warn that gender stereotyping is harmful to girls when it promotes helplessness, dependence and reduces their sense of self-efficacy.

Father’s Role

 Fathers are the principal agents of gender-role socialization, and are generally very insistent that children play with gender-specific toys (Parke, 2002). Fathers also focus more on their sons’ than daughters’ careers and achievements in mathematics and science (DeLisi & McGillicuddy-DeLisi, 2002).
If fathers are absent from when children are young, there may be interruptions in gender identity and gender role in sons, but if there are other male models present, this impact can be mitigated (Hetherington, 1966). Girls are more likely to be affected in adolescence. Daughters of absent fathers have more difficulties in relating to males – daughters of divorcees and single mothers are more sexually precocious, and daughters of widows tend to be shy and anxious about sexuality (Ellis et al., 2003).

Homosexual Parents

Children of homosexual parents develop no differently from children of heterosexual parents: gender typing and gender-role behaviors are identical in each situation, and children of homosexual parents are not more likely to develop homosexual orientations (Patterson & Hastings, 2007). Socioemotional development is also similar in these children.

Other Influences

Media Promotes Stereotypes

Media such as books and television promote gender stereotyping. Males are portrayed as stable, rational, competent and tolerant, and desirable female traits are warmth and sociability. There is an increasing proclivity however, to cast women in a wider range of occupational roles and nontraditional gender roles.

Sibling and Peer Influences

Siblings and peers influence and enforce gender-role standards. Fagot (1985) found that preschoolers treat peers harshly when gender norms are violated, by heckling, ignoring and criticizing them. From preschool until children reach puberty, children primarily associate with the same gender. This is referred to as gender segregation, and in this period, children engage in stereotyped gender activities where boys are active and play rough, while girls are less active and less competitive. Furthermore, girls are boys do not interact much because boys prefer direct demands whereas girls prefer polite requests (Maccoby, 1998).

Schools and Teachers

Schools and teachers send strong signals to children about gender norms. The classroom favors girls because of their verbal orientation and less boisterous, rule-following behaviors. Girls generally enjoy school more, especially in the early grades, and boys struggle to adapt and perform as well as girls, particularly in reading (Halpern, 2000; McCall, Beach, & Lan, 2000).

However, girls’ achievements decline, and by college, girls tend to underachieve more than boys (Wigfield, Eccles, & Schiefele, 2006). Dweck (2001, 2006) attributes this to the detrimental effect of gender stereotyping that influences girls to be less independent thinkers who are less capable of assertive, creative problem-solving. Public achievement for girls is controversial in some circles, and girls may hide their abilities and achievements, especially from boys (Ruble et al. 2006). Even women who have successful careers may underplay their success, be afraid to be assertive or competitive, and have a ‘super-feminine’ appearance.

Teachers promote gender-specific behavior in the classroom, by interrupting girls more, paying more attention to boys’ assertive behaviors than to girls’, and responding more to girls’ social overtures (Hendrick & Stange, 1991). Boys are encouraged more in mathematics, and girls more in literature, and by high school girls are more likely to drop math (Shea, Lubinski, & Benbow, 2001).

Sexual Orientation

ADOLESCENTS

PREDICTORS OF ACCEPTANCE

INFLUENCES

Androgyny

It has been argued that gender stereotyping is psychologically and socially damaging, especially since we know that most people have a combination of male and female attributes – both genders can be fiercely competitive and nurturing, and both genders can excel at activities like sewing, cooking, carpentry and business management.

Androgynous children have masculine and feminine psychological attributes, and are less likely to make stereotyped choices (Bem, 1981, 1998). Research has found that masculine and androgynous children have higher self-esteem than feminine children and are more creative and well-adjusted (Norlander, Erixon, & Archer, 2000; Ruble et al, 2006).

Children’s gender schemas can be modified to be less stereotypical. Adults should thus assist children to be accepting of themselves, and focus less on gender stereotypes and more on activities and occupations that children are interested in.

Knowledge Check

1

Question 1

Please select the correct statement.

  

Self-impaired   concepts often lead to dissatisfaction with gender norms and homosexuality.

 

Sexual   orientation and gender stereotypes are biologically determined.

 

Gender   stereotyping may make girls feel like it is not desirable to be assertive and   independent.

 

Androgyny   is when someone has both male and female sex organs.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Conclusion

This lesson looked at peer interactions, friendship and gender. We firstly looked at how peer interactions develop from infancy to adolescence, and the crucial importance of self-esteem and social skills in peer acceptance. We also looked at the impact of peer acceptance on self-esteem, and how support from adults can help children improve their social skills. Thereafter, we explored friendship, and its characteristics over development. We also discussed the dominance hierarchy of groups, and teenage romance. In the next section of the lesson, we looked at gender. We focused on gender stereotypes and the impact on children’s emotional, intellectual and occupational development. The biological, cognitive and social influences on gender stereotyping were covered. The lesson ended by investigating how children’s sexual orientation may develop, and the benefits of developing more androgynous qualities in children.

KEY TERMS

References

Bagwell, C. L. (2004). Friendships, peer networks and antisocial behavior. In J. B. Kupersmidt & K. A. Dodge (Eds.), Children’s peer relations (pp. 37–57). Washington, DC: American Psychological Association.

Bailey, J. M., Pillard, R. C., Neale, M. C., & Agyei, Y. (1993). Heritable factors influence sexual orientation in women. Archives of General Psychiatry, 50, 217–223.

Bem, S. L. (1981). Gender schema theory: A cognitive account of sex typing. Psychological Review, 88, 354–364.

Bem, S. L. (1998). An unconventional family. New Haven, CT: Yale University Press.

Benenson, J. F., & Christakos, A. (2003). The greater fragility of females’ versus males’ closest same-sex friendships. Child Development, 74, 1123–1129.

Bienert, H., & Schneider, B. H. (1995). Deficit-specific social skills training with peer-nominated aggressive-disruptive and sensitive-isolated preadolescents. Journal of Clinical Child Psychology, 24, 287–299.

Bierman, K. L., Smoot, D. L., & Aumiller, K. (1993). Characteristics of aggressive-rejected, aggressive (nonrejected), and rejected (nonaggressive) boys. Child Development, 64, 139–151.

Bigelow, B. J. (1977). Children’s friendship expectations: A cognitive-developmental study. Child Development, 48, 246–253.

Bigelow, B. J., & LaGaipa, J. J. (1975). Children’s written descriptions of friendship: A multidimensional analysis. Developmental Psychology, 11, 857–858.

Block, J. H. (1983). Differential premises arising from differential socialization of the sexes: Some conjectures. Child Development, 54, 1335–1354.

Brown, E., & Brownell, C. A. (1990). Individual differences in toddlers’ interaction styles. Paper presented at International Conference on Infant Studies, Montreal, Canada.

Burn, S. M., O’Neil, A. K., & Nederend, S. (1996). Childhood tomboyism and adult androgyny. Sex Roles, 34, 419–428.

Casiglia, A. C., Lo Coco, A., & Zappulla, C. (1998). Aspects of social reputation and peer relationships in Italian children: A cross-cultural perspective. Developmental Psychology, 34, 723–730.

Chen, X., Chang, L., & He, Y. (2003). The peer group as context: Mediating and moderating effects on relations between academic achievement and social functioning in Chinese children. Child Development, 74, 710–727.

Cherney, I. D., & London, K. (2006). Gender-linked differences in toys, television shows, computer games, and outdoor activities of 5- to 13-year-old children. Sex Roles, 54, 717–726.

Clark, K. E., & Ladd, G. W. (2000). Connectedness and autonomy support in parent-child relationships: Links to children’s socioemotional orientation and peer relationships. Developmental Psychology, 36, 485–498.

Coie, J. D., & Dodge, K. A. (1983). Continuities and changes in children’s social status: A five-year longitudinal study. Merrill-Palmer Quarterly, 29, 261–282.

Conduct Problems Prevention Research Group. (2004). The Fast Track experiment: Translating the developmental model into a prevention design. In J. B. Kupersmidt & K. A. Dodge (Eds.) Children’s peer relations: From development to intervention (pp. 181–208). Washington, DC: American Psychological Association.

Cowan, C. P., & Cowan, P. A. (2000). When partners become parents: The big life change for couples. Mahwah, NJ: Erlbaum.

Crick, N. R., & Dodge, K. A. (1994). A review and reformulation of social information processing mechanisms in children’s social adjustment. Psychological Bulletin, 115, 74–101.

DeLisi, R., & McGillicuddy-DeLisi, A. V. (2002). Sex differences in mathematical abilities and achievement. In A. V. McGillicuddy & R. DeLisi (Eds.), Biology, society and behavior: The development of sex differences in cognition (pp. 155–182). Westport, CT: Ablex.

DeRosier, M., & Kupersmidt, J. B. (1991). Costa Rican children’s perceptions of their social networks. Developmental Psychology, 27, 656–662.

Dodge, K. A. (1986). A social information processing model of social competence in children. In M. Perlmutter (Ed.), The Minnesota Symposium on Child Psychology: Vol. 18 (pp. 77–125). Hillsdale, NJ: Erlbaum.

Dunn, J. (2004). Children’s friendships. Oxford: Blackwell.

Dweck, C. (2001). Caution—Praise can be dangerous. In K. L. Freiberg (Ed.), Human development 01/02 (9th ed., pp. 105–109). Guilford, CT: Dushkin/McGraw-Hill.

Dweck, C. (2006). Mindset: The new psychology of success. New York, NY: Random House.

Ellis, B. J., Bates, J. E., Dodge, K. A., Fergusson, D. M., Horwood, L. J., Pettit, G. S., et al. (2003). Does father absence place daughters at special risk for early sexual activity and teenage pregnancy? Child Development, 74, 801–821.

Fagot, B. I. (1985a). Beyond the reinforcement principle: Another step toward understanding sex role development. Developmental Psychology, 21, 1097–1104.

French, D. C. (1990). Heterogeneity of peer rejected girls. Child Development, 61, 2028–2031.

Halpern, D. F. (2000). Sex differences in cognitive abilities (3rd ed.). Mahwah, NJ: Erlbaum.

Harter, S. (2006). The self. In W. Damon & R. M. Lerner (Series Eds.), & N. Eisenberg (Vol. Ed.), Handbook of child psychology (6th ed., Vol. 3, pp. 505–570). New York, NY: Wiley.

Hartup, W. W. (1996). The company they keep: Friendships and their developmental significance. Child Development, 67, 1–13.

Hawley, P. H., Johnson, S. E., Mize, J. A., & McNamara, K. A. (2007). Physical attractiveness in preschoolers: Relationships with power, status, aggression and social skills. Journal of School Psychology, 45, 499–521.

Hawley, P. H., & Little, T. D. (1999). On winning some and losing some: A social relations approach to social dominance in toddlers. Merrill-Palmer Quarterly, 45, 188–214.

Hendrick, J., & Stange, T. (1991). Do actions speak louder than words? An effect of the functional use of language on dominant sex role behavior in boys and girls. Early Childhood Research Quarterly, 6, 565–576.

Hetherington, E. M. (1966). Effects of paternal absence on sex-typed behaviors in Negro and white preadolescent males. Journal of Personality and Social Psychology, 4, 87–91.

Hines, M. (2004). Brain gender. New York: Oxford University Press.

Kovacs, D. M., Parker, J. G., & Hoffman, L. W. (1

WEEK 6 FORUM

  

This week, we have discussed issues related to gender and sexuality. You should have some idea of the ways that both biology and society shape our expectations and views of both males and females. Sometimes, however, the issue is not so clear-cut. If you are not familiar with the terms “hermaphrodite” or “intersex,” I suggest that you look them up before participating in this week’s discussion. Then link to and read the following account:
 

www.slate.com/id/2101678/
 

This is obviously a very tragic case on many levels.
 

1.) What does this case tell you about the power of biology?
 

2.) Does it support or refute Dr. Money’s (and others’) apparent view that children are a “blank slate,” and that they can successfully transition from one sex to another if it is done early enough in childhood?
 

3.) Given what happened to David Reimer, what would be your opinion now on whether “sex reassignment surgery” should be done on infants or young children who are born with an intersex condition? Support your argument with empirical research findings. 

READING

Introduction

This lesson will cover peer interactions, friendship and gender. We will begin by exploring how peer interactions develop, and what peer acceptance means in the context of child development. We will investigate how social information-processing functions in popular and unpopular children, and the impact of this on children’s short- and long-term development. We will then move onto friendship, where we will look at what friendship means in the different stages of development. We will look at how groups function, and the importance of teenage romances. We will also look at gender, and the impact of gender stereotypes in child development. We will discuss the role of biology, cognition, family and other social influences on the genders. Lastly, we will have a brief discussion about sexual orientation and androgyny.

Development of Peer Interactions

‹ 1/4 ›

· Early Social Experiences

As we have discussed throughout this course, the home environment has an enormous effect of child development. However, interactions outside the home influence also child development, and the ability to socialize successfully is a cornerstone of development. As the prevalence of preschool education increases, and as more mothers are employed outside the home, children’s ability to socialize at a younger age becomes more significant because of the profound impact social interactions have on a child’s self-esteem. Children’s early social experiences set the foundation for future interactions.

Peer Acceptance

Reinforcement

Children reinforce each other’s behaviors, by ignoring, paying attention to, sharing with, praising and criticizing each other. This ‘peer pressure’ begins from around the age of four, and becomes increasingly powerful as children develop, because being accepted, approved of or ostracized by peers has a tremendous impact on children’s self-esteem.

Social Comparison

Children measure themselves against other children through social comparison, in order to objectively rate and evaluate themselves. How a child is received by peers is highly related to the child’s self-esteem, and defines children’s self-image (Harter, 2006). Positive first experiences can lay the foundation for healthy social behaviors that continue into adulthood.

Sociometric Techniques

Researchers study peer acceptance by measuring each child’s status within peer groups, using sociometric techniques. These measures get the group members to rate each other in characteristics such as aggression, helpfulness and likability (Ladd, 2005).

Popularity

Sociometric techniques have enabled researchers to categorize children’s popularity based on their characteristics and styles of interaction (Bierman, Smoot, & Aumiller, 1993; French, 1990; Ladd, 2005; Parkhurst & Asher, 1992). The nominative technique is a kind of sociometric technique that gets children to select or nominate peers they most like and dislike.

● Popular children receive the most nominations for being well liked, and are prosocial, friendly, good communicators and assertive. However, some popular children have different characteristics. These include being dominant, aggressive, cool, athletic, influential and arrogant.
● Average children do not receive nominations for being well liked or disliked.
● Controversial children receive nominations from being both well liked and disliked.
● Rejected children receive many nominations for being disliked. Aggressive rejected children have behavior problems and little self-control. Nonaggressive rejected children lack social skills, and are withdrawn and anxious.
● Neglected children receive few votes as they are normally friendless and isolated.
We will now look at what drives peers’ judgements of one another.

Social Information-Processing

‹›

· SOCIAL AND COGNITIVE SKILLS

Social and cognitive skills enable children to approach and initiate new social interactions. Socially skilled children want to interact with others. For this to be possible, children need to feel comfortable with others, and this is based on the confidence that they have something useful or valuable to contribute, as well as being interested in finding out about others.

Appearances

Beauty Perceived as Virtue

Although social skills primarily determine children’s social status, there are lesser factors that may contribute. Children and teenagers attribute positive qualities, such as being fearless, friendly, self-sufficient, interpersonally competent and appealing, to people with attractive physical appearances, and attribute negative qualities, such as being aggressive, mean and antisocial, to people with unattractive physical appearances (Hawley, Johnson, Mize, & McNamara, 2007).

Physical Appearance and Treatment

Physically attractive people are treated better, judged more positively and are more popular than unattractive people, and were found to be better adjusted and to have greater intelligence (Langlois et al., 2000). Considering this research in the context of our discussions in previous lessons about the impact of stress, self-esteem and environment factors on cognitive performance, do you think it is possible that an individual’s cognitive performance could be impacted by the way they are treated because of their physical appearance?

Popular Names

Children’s names also have an impact on their social interactions (Rubin, Bukowski, & Parker, 2006). Children with popular names are more acceptable, while children with ‘funny’ names may be less acceptable to their peers. Furthermore, U.S. children generally do not play with children outside their age group, while children from other cultures, such as Africa and Asia, tend to play with children from a far wider range of age groups.

Being Unpopular

 Children can be cruel to those they dislike. Children may exclude, ignore, verbally and physically attack, harass, bully, tease, gossip about and dominate others. Sadly, many rejected children, particularly the nonaggressive ones, are victims of these behaviors.
Unpopular children experience long- and short-term consequences. These include loneliness, social dissatisfaction, alienation and isolation. Academic performance is affected, and these children may avoid or drop out of school. They may be uncooperative and begin to engage in criminal activity. Victimized children may develop depression in early adulthood and be prone to harassment at work. Rejected children usually maintain this status over their lifetime (Coie & Dodge, 1983).

Parents, Teachers, and Peer Acceptance

ATTACHMENT TO PARENTS

ROLE OF ADULTS

SOCIAL COACHING

PROVIDING PLAY OPPORTUNITIES

Watch this video on teaching children social skills at school:

Knowledge Check

1

Question 1

Please select the two correct statements. The most effective ways for adults to help children gain the acceptance of their peers are:

  

To   ensure children have positive social experiences from a young age, especially   within the family.

 

To   train and coach parents and children on social skills.

 

To   ensure the children have the best clothes and toys, and always look great.

 

Peer   acceptance is not that important, therefore adults should not get involved.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Friendship

Hartup (1996) describes friendship as a relationship between equals that includes commitment and reciprocity. Bigelow (1977) and Bigelow and LaGaipa (1975) describe how children’s expectations of friendship progress in three stages. (Please note that the italicized expectations from each stage are carried over to the next stage.)

Friendship tends to develop on the basis of communication, exchanges of information, positive exchanges, common ground, self-disclosure and effective conflict resolution (Parker & Gottman, 1989). Children display more positive affect in interactions with friends, but also disagree more with each other than with nonfriends. Conflicts between friends are usually less heated than with nonfriends, and friends generally try to resolve the conflict in a way that preserves the relationship. While a certain level of conflict in friendship is normal, certain friendships can degenerate into mutual antipathy.

REWARD-COST STAGE

NORMATIVE STAGE

EMPATHETIC STAGE

OLDER CHILDREN

Developmental Stages of Friendship

The goals and processes of friendship change with age.

· PLAY

· PEER ACCEPTANCE

· SELF-UNDERSTANDING

According to Parker and Gottman (1989), until the age of seven, the goal of peer interaction is play, and the processes are geared to facilitate successful play.

Making Friends with or without Keeping Them

An interesting study by Parker and Seal (1996) found that children who make friends easily but do not sustain friendships, know the latest gossip, are ‘playful teasers’, but are also more aggressive, bossy and untrustworthy. However, children who make new friends and sustain friendships are not bossy but are also not pushed around easily.

Intimacy with Few, Isolation from Many

Equally interesting is that the more intimate girl’s friendships are and the more isolated they are from a larger group of friends, the more fragile their relationship is (Benenson & Christakos, 2003). It appears that friendships that are embedded in larger groups may be less fragile because there is more access to alternative partners, allies and third-party mediators. Excessive ‘co-rumination’ between intimate female friends about problems is associated with depression and anxiety, and may intensify problems especially if friends divulge information about their friends to others (Rose, 2002). Boys tend to co-ruminate less, divulge less about their friends to others, and confront their friends directly when there are relationship problems (Rose & Rudolph, 2006).

Benefits of Friendship

Friendship protects against loneliness and depression by providing guidance, support and intimacy. Children with friends have better long-term outcomes. However, some friendships pose risks. Rejected and aggressive children may befriend each other, which often results in unsympathetic, conflictual relationships, as well as deviant behaviors like substance abuse, cheating and aggression (Bagwell, 2004; Poulin, Dishion, & Haas, 1999).

Groups

Dominance Hierarchy

Being part of a group is associated with increased well-being and healthier stress management. Groups always have a dominance hierarchy, which is evident in children as young as two (Hawley & Little, 1999). Hierarchy is established within the first 45 minutes of contact (Pettit, Bakshi, Dodge, & Coie, 1990). Hierarchy promotes social organization and regulation, whereby nonaggressive conflict resolution is orchestrated by higher ranking members, tasks are divided and lower ranking members are allocated working roles and higher ranking members assume leadership roles, and resources are allocated.

Culture

Culture plays a role in the characteristics of peer groups. For example, Israeli children in rural kibbutzim are found to be more cooperative than children from cities, African American children have more opposite-gender friendships, Japanese and Latino children are more family oriented, and Italian children engage in more disputes and debates with friends but have more stable friendships – perhaps due to the higher tolerance for conflict (Casiglia, Lo Coco, & Zappulla, 1998; deRosier & Kupersmidt, 1991; Kovacs, Parker, & Hoffman, 1996; Schneider, 2000). Chinese children form more cliques based on academic achievement (Chen, et al., 2003).

Romance

Adolescent romance is an important developmental milestone. Nurturant parenting is associated with better quality romantic relationships, while inadequate parenting is associated with more violent, aggressive and destructive romances. We will now briefly highlight three common myths about teenage love affairs, as outlined by Parke and Gauvain (2009).

Click on the buttons below to find the reality:

MYTH 1: THESE RELATIONSHIPS ARE TEMPORARY.

MYTH 2: THESE RELATIONSHIPS ARE INCONSEQUENTIAL.

MYTH 3: ADOLESCENT ROMANTIC RELATIONSHIPS ARE INDICATIVE OF PROBLEM BEHAVIORS.

As adolescents get older, the importance of peer-approval of romantic partners decreases, while the importance of shared values and interests, interdependence, compatibility and personality increase.

Knowledge Check

1

Question 1

Please select the two most accurate depictions of how social relationships develop in children and adolescents.

  

Younger   children have more friends of the same-sex. Adolescents begin to associate   more with members of the opposite sex and have romances.

 

Younger   children start at the bottom of the group hierarchy and as they age, they   work their way up to being dominant group members.

 

The   focus changes from play, to social acceptance, to self-understanding.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Gender

There are obvious differences associated with males and females, including genetics, hormones, tendencies, behaviors including reproduction, appearance, roles, the way they are treated and expectations placed on them. However, there are also many similarities between the genders.

· GENDER TYPING

· GENDER IDENTITY

Children learn to differentiate which behaviors, values and motivations are attributed to males and females in a process called gender typing. Gender typing is based on gender stereotypes which tell us what is expected of and acceptable for each gender. Parents and other people act as agents of gender socializing.

As you watch this video on gender stereotyping, assess how children may be influenced to develop academically and intellectually based on gender typing.

Gender Stereotypes

Gender Roles Similar Worldwide

On the whole, cultures across the globe are consistent with the roles they allocate to each gender. Men are typically expected to be assertive, dominant and competitive, and women are expected to be more passive, sensitive, loving and sociable. While not always helpful in promoting gender equality, these stereotypes have generally tended to stick.

Play Preferences

For instance, research on one-year olds found that girls show preferences for dolls, while boys show preferences for vehicles (Serbin, Poulin-Dubois, Colburne, Sen & Eichstedt, 2001). Moreover, while college educated women are more likely to be advocates of female independence and achievement, men – even well-educated ones, maintain stereotyped gender-role standards, especially of their children.

Stereotypes

Why is this? The male role, particularly in Western culture, is esteemed with greater status and privileges, but is also more clearly defined, thus pressuring males into conforming to certain roles and behaviors. It is thought-provoking to note that it is normally more acceptable for girls to partake in masculine activities, and that when boys partake in feminine activities they are often ridiculed for being ‘sissies’. How do you think this relates to masculinity being ascribed a higher status that femininity?

Interests and Culture

If children’s interests are consistent with cultural standards on what is gender-appropriate, these interests tend to continue into adulthood, however, if they are not consistent, these interests rarely continue into adulthood. Moreover, Cherney and London (2006) found that boys generally develop more intense interests in gender stereotyped activities and events than girls, that last longer in the male lifespan that females’ gender stereotyped interests last.

Tendency to Follow Stereotype

While children, especially girls, may participate to a degree in both male and female pursuits, in adolescence they tend to adhere more strictly to gender stereotypes, perhaps due to increased pressure from peers, parents, other social influencers and their interest in romantic relationships (Burn, O’Neil, & Nederend, 1996). When adults become parents, gender roles also tend to become more defined, where females display expressive characteristics, such as empathy and nurturing the child, while males display more instrumental characteristics, by focusing on occupation and tasks (Cowan & Cowan, 2000).

Knowledge Check

1

Question 1

Please select the correct statement.

  

Children’s   interests and academic path have nothing to do with gender stereotyping.

 

Typical   masculine gender roles emanate from their expressive characteristics.

 

Children   chose their toys based on their gender-role preferences.

 

Gender   typing describes the types of things that are acceptable for each gender.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Biological Differences

· HORMONES

· BRAIN LATERALIZATION

· COGNITIVE FACTORS

Hormones are chemical substances that regulate certain organs, characteristics and functions. As we discussed in the second lesson, the male’s principal hormone is testosterone, and the female’s principal hormones are estrogen and progesterone. These hormones organize the fetus’s biological and psychological predispositions.

There are differences in the genders’ verbal and spatial abilities from a young age, which Hines (2004) attributes to prenatal hormones. For instance, higher androgen (male hormone) levels are associated with better visual-spatial skills. Research has also determined that when girls have more testosterone, they acquire masculine characteristics like being more assertive and enjoying rough physical play (Reiner & Gearhart, 2004).

Family Influences

Parental Influence on Gender-typing

Parents influence their children’s gender-typing and gender-role behaviors by the way they speak to them, treat them, dress them, play with them, the kinds of activities, toys, interactions and opportunities they provide, and by their modeling. From the time children are born, parents focus on their son’s alertness, size, coordination and strength, and on their daughter’s beauty, gentleness and fragility (Stern & Karraker, 1989). Parents play more with their sons, engage more in rough-and-tumble, touch them more, and speak to them in a ‘macho’ way. Boys are encouraged to be independent, and to explore, compete and achieve more (Ruble, Martin, & Berenbaum, 2006).

Sons and Daughters are Treated Differently

Parents teach sons more, but focus more on emotions and interpersonal interactions with daughters (Block, 1983). Parents cuddle girls more, talk to them more, use directive, supportive speech, and are more protective over them (Leaper & Friedman, 2007). They also encourage daughters to be more dependent. Psychologists warn that gender stereotyping is harmful to girls when it promotes helplessness, dependence and reduces their sense of self-efficacy.

Father’s Role

 Fathers are the principal agents of gender-role socialization, and are generally very insistent that children play with gender-specific toys (Parke, 2002). Fathers also focus more on their sons’ than daughters’ careers and achievements in mathematics and science (DeLisi & McGillicuddy-DeLisi, 2002).
If fathers are absent from when children are young, there may be interruptions in gender identity and gender role in sons, but if there are other male models present, this impact can be mitigated (Hetherington, 1966). Girls are more likely to be affected in adolescence. Daughters of absent fathers have more difficulties in relating to males – daughters of divorcees and single mothers are more sexually precocious, and daughters of widows tend to be shy and anxious about sexuality (Ellis et al., 2003).

Homosexual Parents

Children of homosexual parents develop no differently from children of heterosexual parents: gender typing and gender-role behaviors are identical in each situation, and children of homosexual parents are not more likely to develop homosexual orientations (Patterson & Hastings, 2007). Socioemotional development is also similar in these children.

Other Influences

Media Promotes Stereotypes

Media such as books and television promote gender stereotyping. Males are portrayed as stable, rational, competent and tolerant, and desirable female traits are warmth and sociability. There is an increasing proclivity however, to cast women in a wider range of occupational roles and nontraditional gender roles.

Sibling and Peer Influences

Siblings and peers influence and enforce gender-role standards. Fagot (1985) found that preschoolers treat peers harshly when gender norms are violated, by heckling, ignoring and criticizing them. From preschool until children reach puberty, children primarily associate with the same gender. This is referred to as gender segregation, and in this period, children engage in stereotyped gender activities where boys are active and play rough, while girls are less active and less competitive. Furthermore, girls are boys do not interact much because boys prefer direct demands whereas girls prefer polite requests (Maccoby, 1998).

Schools and Teachers

Schools and teachers send strong signals to children about gender norms. The classroom favors girls because of their verbal orientation and less boisterous, rule-following behaviors. Girls generally enjoy school more, especially in the early grades, and boys struggle to adapt and perform as well as girls, particularly in reading (Halpern, 2000; McCall, Beach, & Lan, 2000).

However, girls’ achievements decline, and by college, girls tend to underachieve more than boys (Wigfield, Eccles, & Schiefele, 2006). Dweck (2001, 2006) attributes this to the detrimental effect of gender stereotyping that influences girls to be less independent thinkers who are less capable of assertive, creative problem-solving. Public achievement for girls is controversial in some circles, and girls may hide their abilities and achievements, especially from boys (Ruble et al. 2006). Even women who have successful careers may underplay their success, be afraid to be assertive or competitive, and have a ‘super-feminine’ appearance.

Teachers promote gender-specific behavior in the classroom, by interrupting girls more, paying more attention to boys’ assertive behaviors than to girls’, and responding more to girls’ social overtures (Hendrick & Stange, 1991). Boys are encouraged more in mathematics, and girls more in literature, and by high school girls are more likely to drop math (Shea, Lubinski, & Benbow, 2001).

Sexual Orientation

ADOLESCENTS

PREDICTORS OF ACCEPTANCE

INFLUENCES

Androgyny

It has been argued that gender stereotyping is psychologically and socially damaging, especially since we know that most people have a combination of male and female attributes – both genders can be fiercely competitive and nurturing, and both genders can excel at activities like sewing, cooking, carpentry and business management.

Androgynous children have masculine and feminine psychological attributes, and are less likely to make stereotyped choices (Bem, 1981, 1998). Research has found that masculine and androgynous children have higher self-esteem than feminine children and are more creative and well-adjusted (Norlander, Erixon, & Archer, 2000; Ruble et al, 2006).

Children’s gender schemas can be modified to be less stereotypical. Adults should thus assist children to be accepting of themselves, and focus less on gender stereotypes and more on activities and occupations that children are interested in.

Knowledge Check

1

Question 1

Please select the correct statement.

  

Self-impaired   concepts often lead to dissatisfaction with gender norms and homosexuality.

 

Sexual   orientation and gender stereotypes are biologically determined.

 

Gender   stereotyping may make girls feel like it is not desirable to be assertive and   independent.

 

Androgyny   is when someone has both male and female sex organs.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Conclusion

This lesson looked at peer interactions, friendship and gender. We firstly looked at how peer interactions develop from infancy to adolescence, and the crucial importance of self-esteem and social skills in peer acceptance. We also looked at the impact of peer acceptance on self-esteem, and how support from adults can help children improve their social skills. Thereafter, we explored friendship, and its characteristics over development. We also discussed the dominance hierarchy of groups, and teenage romance. In the next section of the lesson, we looked at gender. We focused on gender stereotypes and the impact on children’s emotional, intellectual and occupational development. The biological, cognitive and social influences on gender stereotyping were covered. The lesson ended by investigating how children’s sexual orientation may develop, and the benefits of developing more androgynous qualities in children.

KEY TERMS

References

Bagwell, C. L. (2004). Friendships, peer networks and antisocial behavior. In J. B. Kupersmidt & K. A. Dodge (Eds.), Children’s peer relations (pp. 37–57). Washington, DC: American Psychological Association.

Bailey, J. M., Pillard, R. C., Neale, M. C., & Agyei, Y. (1993). Heritable factors influence sexual orientation in women. Archives of General Psychiatry, 50, 217–223.

Bem, S. L. (1981). Gender schema theory: A cognitive account of sex typing. Psychological Review, 88, 354–364.

Bem, S. L. (1998). An unconventional family. New Haven, CT: Yale University Press.

Benenson, J. F., & Christakos, A. (2003). The greater fragility of females’ versus males’ closest same-sex friendships. Child Development, 74, 1123–1129.

Bienert, H., & Schneider, B. H. (1995). Deficit-specific social skills training with peer-nominated aggressive-disruptive and sensitive-isolated preadolescents. Journal of Clinical Child Psychology, 24, 287–299.

Bierman, K. L., Smoot, D. L., & Aumiller, K. (1993). Characteristics of aggressive-rejected, aggressive (nonrejected), and rejected (nonaggressive) boys. Child Development, 64, 139–151.

Bigelow, B. J. (1977). Children’s friendship expectations: A cognitive-developmental study. Child Development, 48, 246–253.

Bigelow, B. J., & LaGaipa, J. J. (1975). Children’s written descriptions of friendship: A multidimensional analysis. Developmental Psychology, 11, 857–858.

Block, J. H. (1983). Differential premises arising from differential socialization of the sexes: Some conjectures. Child Development, 54, 1335–1354.

Brown, E., & Brownell, C. A. (1990). Individual differences in toddlers’ interaction styles. Paper presented at International Conference on Infant Studies, Montreal, Canada.

Burn, S. M., O’Neil, A. K., & Nederend, S. (1996). Childhood tomboyism and adult androgyny. Sex Roles, 34, 419–428.

Casiglia, A. C., Lo Coco, A., & Zappulla, C. (1998). Aspects of social reputation and peer relationships in Italian children: A cross-cultural perspective. Developmental Psychology, 34, 723–730.

Chen, X., Chang, L., & He, Y. (2003). The peer group as context: Mediating and moderating effects on relations between academic achievement and social functioning in Chinese children. Child Development, 74, 710–727.

Cherney, I. D., & London, K. (2006). Gender-linked differences in toys, television shows, computer games, and outdoor activities of 5- to 13-year-old children. Sex Roles, 54, 717–726.

Clark, K. E., & Ladd, G. W. (2000). Connectedness and autonomy support in parent-child relationships: Links to children’s socioemotional orientation and peer relationships. Developmental Psychology, 36, 485–498.

Coie, J. D., & Dodge, K. A. (1983). Continuities and changes in children’s social status: A five-year longitudinal study. Merrill-Palmer Quarterly, 29, 261–282.

Conduct Problems Prevention Research Group. (2004). The Fast Track experiment: Translating the developmental model into a prevention design. In J. B. Kupersmidt & K. A. Dodge (Eds.) Children’s peer relations: From development to intervention (pp. 181–208). Washington, DC: American Psychological Association.

Cowan, C. P., & Cowan, P. A. (2000). When partners become parents: The big life change for couples. Mahwah, NJ: Erlbaum.

Crick, N. R., & Dodge, K. A. (1994). A review and reformulation of social information processing mechanisms in children’s social adjustment. Psychological Bulletin, 115, 74–101.

DeLisi, R., & McGillicuddy-DeLisi, A. V. (2002). Sex differences in mathematical abilities and achievement. In A. V. McGillicuddy & R. DeLisi (Eds.), Biology, society and behavior: The development of sex differences in cognition (pp. 155–182). Westport, CT: Ablex.

DeRosier, M., & Kupersmidt, J. B. (1991). Costa Rican children’s perceptions of their social networks. Developmental Psychology, 27, 656–662.

Dodge, K. A. (1986). A social information processing model of social competence in children. In M. Perlmutter (Ed.), The Minnesota Symposium on Child Psychology: Vol. 18 (pp. 77–125). Hillsdale, NJ: Erlbaum.

Dunn, J. (2004). Children’s friendships. Oxford: Blackwell.

Dweck, C. (2001). Caution—Praise can be dangerous. In K. L. Freiberg (Ed.), Human development 01/02 (9th ed., pp. 105–109). Guilford, CT: Dushkin/McGraw-Hill.

Dweck, C. (2006). Mindset: The new psychology of success. New York, NY: Random House.

Ellis, B. J., Bates, J. E., Dodge, K. A., Fergusson, D. M., Horwood, L. J., Pettit, G. S., et al. (2003). Does father absence place daughters at special risk for early sexual activity and teenage pregnancy? Child Development, 74, 801–821.

Fagot, B. I. (1985a). Beyond the reinforcement principle: Another step toward understanding sex role development. Developmental Psychology, 21, 1097–1104.

French, D. C. (1990). Heterogeneity of peer rejected girls. Child Development, 61, 2028–2031.

Halpern, D. F. (2000). Sex differences in cognitive abilities (3rd ed.). Mahwah, NJ: Erlbaum.

Harter, S. (2006). The self. In W. Damon & R. M. Lerner (Series Eds.), & N. Eisenberg (Vol. Ed.), Handbook of child psychology (6th ed., Vol. 3, pp. 505–570). New York, NY: Wiley.

Hartup, W. W. (1996). The company they keep: Friendships and their developmental significance. Child Development, 67, 1–13.

Hawley, P. H., Johnson, S. E., Mize, J. A., & McNamara, K. A. (2007). Physical attractiveness in preschoolers: Relationships with power, status, aggression and social skills. Journal of School Psychology, 45, 499–521.

Hawley, P. H., & Little, T. D. (1999). On winning some and losing some: A social relations approach to social dominance in toddlers. Merrill-Palmer Quarterly, 45, 188–214.

Hendrick, J., & Stange, T. (1991). Do actions speak louder than words? An effect of the functional use of language on dominant sex role behavior in boys and girls. Early Childhood Research Quarterly, 6, 565–576.

Hetherington, E. M. (1966). Effects of paternal absence on sex-typed behaviors in Negro and white preadolescent males. Journal of Personality and Social Psychology, 4, 87–91.

Hines, M. (2004). Brain gender. New York: Oxford University Press.

Kovacs, D. M., Parker, J. G., & Hoffman, L. W. (1

WEEK 6 FORUM

  

This week, we have discussed issues related to gender and sexuality. You should have some idea of the ways that both biology and society shape our expectations and views of both males and females. Sometimes, however, the issue is not so clear-cut. If you are not familiar with the terms “hermaphrodite” or “intersex,” I suggest that you look them up before participating in this week’s discussion. Then link to and read the following account:
 

www.slate.com/id/2101678/
 

This is obviously a very tragic case on many levels.
 

1.) What does this case tell you about the power of biology?
 

2.) Does it support or refute Dr. Money’s (and others’) apparent view that children are a “blank slate,” and that they can successfully transition from one sex to another if it is done early enough in childhood?
 

3.) Given what happened to David Reimer, what would be your opinion now on whether “sex reassignment surgery” should be done on infants or young children who are born with an intersex condition? Support your argument with empirical research findings. 

READING

Introduction

This lesson will cover peer interactions, friendship and gender. We will begin by exploring how peer interactions develop, and what peer acceptance means in the context of child development. We will investigate how social information-processing functions in popular and unpopular children, and the impact of this on children’s short- and long-term development. We will then move onto friendship, where we will look at what friendship means in the different stages of development. We will look at how groups function, and the importance of teenage romances. We will also look at gender, and the impact of gender stereotypes in child development. We will discuss the role of biology, cognition, family and other social influences on the genders. Lastly, we will have a brief discussion about sexual orientation and androgyny.

Development of Peer Interactions

‹ 1/4 ›

· Early Social Experiences

As we have discussed throughout this course, the home environment has an enormous effect of child development. However, interactions outside the home influence also child development, and the ability to socialize successfully is a cornerstone of development. As the prevalence of preschool education increases, and as more mothers are employed outside the home, children’s ability to socialize at a younger age becomes more significant because of the profound impact social interactions have on a child’s self-esteem. Children’s early social experiences set the foundation for future interactions.

Peer Acceptance

Reinforcement

Children reinforce each other’s behaviors, by ignoring, paying attention to, sharing with, praising and criticizing each other. This ‘peer pressure’ begins from around the age of four, and becomes increasingly powerful as children develop, because being accepted, approved of or ostracized by peers has a tremendous impact on children’s self-esteem.

Social Comparison

Children measure themselves against other children through social comparison, in order to objectively rate and evaluate themselves. How a child is received by peers is highly related to the child’s self-esteem, and defines children’s self-image (Harter, 2006). Positive first experiences can lay the foundation for healthy social behaviors that continue into adulthood.

Sociometric Techniques

Researchers study peer acceptance by measuring each child’s status within peer groups, using sociometric techniques. These measures get the group members to rate each other in characteristics such as aggression, helpfulness and likability (Ladd, 2005).

Popularity

Sociometric techniques have enabled researchers to categorize children’s popularity based on their characteristics and styles of interaction (Bierman, Smoot, & Aumiller, 1993; French, 1990; Ladd, 2005; Parkhurst & Asher, 1992). The nominative technique is a kind of sociometric technique that gets children to select or nominate peers they most like and dislike.

● Popular children receive the most nominations for being well liked, and are prosocial, friendly, good communicators and assertive. However, some popular children have different characteristics. These include being dominant, aggressive, cool, athletic, influential and arrogant.
● Average children do not receive nominations for being well liked or disliked.
● Controversial children receive nominations from being both well liked and disliked.
● Rejected children receive many nominations for being disliked. Aggressive rejected children have behavior problems and little self-control. Nonaggressive rejected children lack social skills, and are withdrawn and anxious.
● Neglected children receive few votes as they are normally friendless and isolated.
We will now look at what drives peers’ judgements of one another.

Social Information-Processing

‹›

· SOCIAL AND COGNITIVE SKILLS

Social and cognitive skills enable children to approach and initiate new social interactions. Socially skilled children want to interact with others. For this to be possible, children need to feel comfortable with others, and this is based on the confidence that they have something useful or valuable to contribute, as well as being interested in finding out about others.

Appearances

Beauty Perceived as Virtue

Although social skills primarily determine children’s social status, there are lesser factors that may contribute. Children and teenagers attribute positive qualities, such as being fearless, friendly, self-sufficient, interpersonally competent and appealing, to people with attractive physical appearances, and attribute negative qualities, such as being aggressive, mean and antisocial, to people with unattractive physical appearances (Hawley, Johnson, Mize, & McNamara, 2007).

Physical Appearance and Treatment

Physically attractive people are treated better, judged more positively and are more popular than unattractive people, and were found to be better adjusted and to have greater intelligence (Langlois et al., 2000). Considering this research in the context of our discussions in previous lessons about the impact of stress, self-esteem and environment factors on cognitive performance, do you think it is possible that an individual’s cognitive performance could be impacted by the way they are treated because of their physical appearance?

Popular Names

Children’s names also have an impact on their social interactions (Rubin, Bukowski, & Parker, 2006). Children with popular names are more acceptable, while children with ‘funny’ names may be less acceptable to their peers. Furthermore, U.S. children generally do not play with children outside their age group, while children from other cultures, such as Africa and Asia, tend to play with children from a far wider range of age groups.

Being Unpopular

 Children can be cruel to those they dislike. Children may exclude, ignore, verbally and physically attack, harass, bully, tease, gossip about and dominate others. Sadly, many rejected children, particularly the nonaggressive ones, are victims of these behaviors.
Unpopular children experience long- and short-term consequences. These include loneliness, social dissatisfaction, alienation and isolation. Academic performance is affected, and these children may avoid or drop out of school. They may be uncooperative and begin to engage in criminal activity. Victimized children may develop depression in early adulthood and be prone to harassment at work. Rejected children usually maintain this status over their lifetime (Coie & Dodge, 1983).

Parents, Teachers, and Peer Acceptance

ATTACHMENT TO PARENTS

ROLE OF ADULTS

SOCIAL COACHING

PROVIDING PLAY OPPORTUNITIES

Watch this video on teaching children social skills at school:

Knowledge Check

1

Question 1

Please select the two correct statements. The most effective ways for adults to help children gain the acceptance of their peers are:

  

To   ensure children have positive social experiences from a young age, especially   within the family.

 

To   train and coach parents and children on social skills.

 

To   ensure the children have the best clothes and toys, and always look great.

 

Peer   acceptance is not that important, therefore adults should not get involved.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Friendship

Hartup (1996) describes friendship as a relationship between equals that includes commitment and reciprocity. Bigelow (1977) and Bigelow and LaGaipa (1975) describe how children’s expectations of friendship progress in three stages. (Please note that the italicized expectations from each stage are carried over to the next stage.)

Friendship tends to develop on the basis of communication, exchanges of information, positive exchanges, common ground, self-disclosure and effective conflict resolution (Parker & Gottman, 1989). Children display more positive affect in interactions with friends, but also disagree more with each other than with nonfriends. Conflicts between friends are usually less heated than with nonfriends, and friends generally try to resolve the conflict in a way that preserves the relationship. While a certain level of conflict in friendship is normal, certain friendships can degenerate into mutual antipathy.

REWARD-COST STAGE

NORMATIVE STAGE

EMPATHETIC STAGE

OLDER CHILDREN

Developmental Stages of Friendship

The goals and processes of friendship change with age.

· PLAY

· PEER ACCEPTANCE

· SELF-UNDERSTANDING

According to Parker and Gottman (1989), until the age of seven, the goal of peer interaction is play, and the processes are geared to facilitate successful play.

Making Friends with or without Keeping Them

An interesting study by Parker and Seal (1996) found that children who make friends easily but do not sustain friendships, know the latest gossip, are ‘playful teasers’, but are also more aggressive, bossy and untrustworthy. However, children who make new friends and sustain friendships are not bossy but are also not pushed around easily.

Intimacy with Few, Isolation from Many

Equally interesting is that the more intimate girl’s friendships are and the more isolated they are from a larger group of friends, the more fragile their relationship is (Benenson & Christakos, 2003). It appears that friendships that are embedded in larger groups may be less fragile because there is more access to alternative partners, allies and third-party mediators. Excessive ‘co-rumination’ between intimate female friends about problems is associated with depression and anxiety, and may intensify problems especially if friends divulge information about their friends to others (Rose, 2002). Boys tend to co-ruminate less, divulge less about their friends to others, and confront their friends directly when there are relationship problems (Rose & Rudolph, 2006).

Benefits of Friendship

Friendship protects against loneliness and depression by providing guidance, support and intimacy. Children with friends have better long-term outcomes. However, some friendships pose risks. Rejected and aggressive children may befriend each other, which often results in unsympathetic, conflictual relationships, as well as deviant behaviors like substance abuse, cheating and aggression (Bagwell, 2004; Poulin, Dishion, & Haas, 1999).

Groups

Dominance Hierarchy

Being part of a group is associated with increased well-being and healthier stress management. Groups always have a dominance hierarchy, which is evident in children as young as two (Hawley & Little, 1999). Hierarchy is established within the first 45 minutes of contact (Pettit, Bakshi, Dodge, & Coie, 1990). Hierarchy promotes social organization and regulation, whereby nonaggressive conflict resolution is orchestrated by higher ranking members, tasks are divided and lower ranking members are allocated working roles and higher ranking members assume leadership roles, and resources are allocated.

Culture

Culture plays a role in the characteristics of peer groups. For example, Israeli children in rural kibbutzim are found to be more cooperative than children from cities, African American children have more opposite-gender friendships, Japanese and Latino children are more family oriented, and Italian children engage in more disputes and debates with friends but have more stable friendships – perhaps due to the higher tolerance for conflict (Casiglia, Lo Coco, & Zappulla, 1998; deRosier & Kupersmidt, 1991; Kovacs, Parker, & Hoffman, 1996; Schneider, 2000). Chinese children form more cliques based on academic achievement (Chen, et al., 2003).

Romance

Adolescent romance is an important developmental milestone. Nurturant parenting is associated with better quality romantic relationships, while inadequate parenting is associated with more violent, aggressive and destructive romances. We will now briefly highlight three common myths about teenage love affairs, as outlined by Parke and Gauvain (2009).

Click on the buttons below to find the reality:

MYTH 1: THESE RELATIONSHIPS ARE TEMPORARY.

MYTH 2: THESE RELATIONSHIPS ARE INCONSEQUENTIAL.

MYTH 3: ADOLESCENT ROMANTIC RELATIONSHIPS ARE INDICATIVE OF PROBLEM BEHAVIORS.

As adolescents get older, the importance of peer-approval of romantic partners decreases, while the importance of shared values and interests, interdependence, compatibility and personality increase.

Knowledge Check

1

Question 1

Please select the two most accurate depictions of how social relationships develop in children and adolescents.

  

Younger   children have more friends of the same-sex. Adolescents begin to associate   more with members of the opposite sex and have romances.

 

Younger   children start at the bottom of the group hierarchy and as they age, they   work their way up to being dominant group members.

 

The   focus changes from play, to social acceptance, to self-understanding.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Gender

There are obvious differences associated with males and females, including genetics, hormones, tendencies, behaviors including reproduction, appearance, roles, the way they are treated and expectations placed on them. However, there are also many similarities between the genders.

· GENDER TYPING

· GENDER IDENTITY

Children learn to differentiate which behaviors, values and motivations are attributed to males and females in a process called gender typing. Gender typing is based on gender stereotypes which tell us what is expected of and acceptable for each gender. Parents and other people act as agents of gender socializing.

As you watch this video on gender stereotyping, assess how children may be influenced to develop academically and intellectually based on gender typing.

Gender Stereotypes

Gender Roles Similar Worldwide

On the whole, cultures across the globe are consistent with the roles they allocate to each gender. Men are typically expected to be assertive, dominant and competitive, and women are expected to be more passive, sensitive, loving and sociable. While not always helpful in promoting gender equality, these stereotypes have generally tended to stick.

Play Preferences

For instance, research on one-year olds found that girls show preferences for dolls, while boys show preferences for vehicles (Serbin, Poulin-Dubois, Colburne, Sen & Eichstedt, 2001). Moreover, while college educated women are more likely to be advocates of female independence and achievement, men – even well-educated ones, maintain stereotyped gender-role standards, especially of their children.

Stereotypes

Why is this? The male role, particularly in Western culture, is esteemed with greater status and privileges, but is also more clearly defined, thus pressuring males into conforming to certain roles and behaviors. It is thought-provoking to note that it is normally more acceptable for girls to partake in masculine activities, and that when boys partake in feminine activities they are often ridiculed for being ‘sissies’. How do you think this relates to masculinity being ascribed a higher status that femininity?

Interests and Culture

If children’s interests are consistent with cultural standards on what is gender-appropriate, these interests tend to continue into adulthood, however, if they are not consistent, these interests rarely continue into adulthood. Moreover, Cherney and London (2006) found that boys generally develop more intense interests in gender stereotyped activities and events than girls, that last longer in the male lifespan that females’ gender stereotyped interests last.

Tendency to Follow Stereotype

While children, especially girls, may participate to a degree in both male and female pursuits, in adolescence they tend to adhere more strictly to gender stereotypes, perhaps due to increased pressure from peers, parents, other social influencers and their interest in romantic relationships (Burn, O’Neil, & Nederend, 1996). When adults become parents, gender roles also tend to become more defined, where females display expressive characteristics, such as empathy and nurturing the child, while males display more instrumental characteristics, by focusing on occupation and tasks (Cowan & Cowan, 2000).

Knowledge Check

1

Question 1

Please select the correct statement.

  

Children’s   interests and academic path have nothing to do with gender stereotyping.

 

Typical   masculine gender roles emanate from their expressive characteristics.

 

Children   chose their toys based on their gender-role preferences.

 

Gender   typing describes the types of things that are acceptable for each gender.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Biological Differences

· HORMONES

· BRAIN LATERALIZATION

· COGNITIVE FACTORS

Hormones are chemical substances that regulate certain organs, characteristics and functions. As we discussed in the second lesson, the male’s principal hormone is testosterone, and the female’s principal hormones are estrogen and progesterone. These hormones organize the fetus’s biological and psychological predispositions.

There are differences in the genders’ verbal and spatial abilities from a young age, which Hines (2004) attributes to prenatal hormones. For instance, higher androgen (male hormone) levels are associated with better visual-spatial skills. Research has also determined that when girls have more testosterone, they acquire masculine characteristics like being more assertive and enjoying rough physical play (Reiner & Gearhart, 2004).

Family Influences

Parental Influence on Gender-typing

Parents influence their children’s gender-typing and gender-role behaviors by the way they speak to them, treat them, dress them, play with them, the kinds of activities, toys, interactions and opportunities they provide, and by their modeling. From the time children are born, parents focus on their son’s alertness, size, coordination and strength, and on their daughter’s beauty, gentleness and fragility (Stern & Karraker, 1989). Parents play more with their sons, engage more in rough-and-tumble, touch them more, and speak to them in a ‘macho’ way. Boys are encouraged to be independent, and to explore, compete and achieve more (Ruble, Martin, & Berenbaum, 2006).

Sons and Daughters are Treated Differently

Parents teach sons more, but focus more on emotions and interpersonal interactions with daughters (Block, 1983). Parents cuddle girls more, talk to them more, use directive, supportive speech, and are more protective over them (Leaper & Friedman, 2007). They also encourage daughters to be more dependent. Psychologists warn that gender stereotyping is harmful to girls when it promotes helplessness, dependence and reduces their sense of self-efficacy.

Father’s Role

 Fathers are the principal agents of gender-role socialization, and are generally very insistent that children play with gender-specific toys (Parke, 2002). Fathers also focus more on their sons’ than daughters’ careers and achievements in mathematics and science (DeLisi & McGillicuddy-DeLisi, 2002).
If fathers are absent from when children are young, there may be interruptions in gender identity and gender role in sons, but if there are other male models present, this impact can be mitigated (Hetherington, 1966). Girls are more likely to be affected in adolescence. Daughters of absent fathers have more difficulties in relating to males – daughters of divorcees and single mothers are more sexually precocious, and daughters of widows tend to be shy and anxious about sexuality (Ellis et al., 2003).

Homosexual Parents

Children of homosexual parents develop no differently from children of heterosexual parents: gender typing and gender-role behaviors are identical in each situation, and children of homosexual parents are not more likely to develop homosexual orientations (Patterson & Hastings, 2007). Socioemotional development is also similar in these children.

Other Influences

Media Promotes Stereotypes

Media such as books and television promote gender stereotyping. Males are portrayed as stable, rational, competent and tolerant, and desirable female traits are warmth and sociability. There is an increasing proclivity however, to cast women in a wider range of occupational roles and nontraditional gender roles.

Sibling and Peer Influences

Siblings and peers influence and enforce gender-role standards. Fagot (1985) found that preschoolers treat peers harshly when gender norms are violated, by heckling, ignoring and criticizing them. From preschool until children reach puberty, children primarily associate with the same gender. This is referred to as gender segregation, and in this period, children engage in stereotyped gender activities where boys are active and play rough, while girls are less active and less competitive. Furthermore, girls are boys do not interact much because boys prefer direct demands whereas girls prefer polite requests (Maccoby, 1998).

Schools and Teachers

Schools and teachers send strong signals to children about gender norms. The classroom favors girls because of their verbal orientation and less boisterous, rule-following behaviors. Girls generally enjoy school more, especially in the early grades, and boys struggle to adapt and perform as well as girls, particularly in reading (Halpern, 2000; McCall, Beach, & Lan, 2000).

However, girls’ achievements decline, and by college, girls tend to underachieve more than boys (Wigfield, Eccles, & Schiefele, 2006). Dweck (2001, 2006) attributes this to the detrimental effect of gender stereotyping that influences girls to be less independent thinkers who are less capable of assertive, creative problem-solving. Public achievement for girls is controversial in some circles, and girls may hide their abilities and achievements, especially from boys (Ruble et al. 2006). Even women who have successful careers may underplay their success, be afraid to be assertive or competitive, and have a ‘super-feminine’ appearance.

Teachers promote gender-specific behavior in the classroom, by interrupting girls more, paying more attention to boys’ assertive behaviors than to girls’, and responding more to girls’ social overtures (Hendrick & Stange, 1991). Boys are encouraged more in mathematics, and girls more in literature, and by high school girls are more likely to drop math (Shea, Lubinski, & Benbow, 2001).

Sexual Orientation

ADOLESCENTS

PREDICTORS OF ACCEPTANCE

INFLUENCES

Androgyny

It has been argued that gender stereotyping is psychologically and socially damaging, especially since we know that most people have a combination of male and female attributes – both genders can be fiercely competitive and nurturing, and both genders can excel at activities like sewing, cooking, carpentry and business management.

Androgynous children have masculine and feminine psychological attributes, and are less likely to make stereotyped choices (Bem, 1981, 1998). Research has found that masculine and androgynous children have higher self-esteem than feminine children and are more creative and well-adjusted (Norlander, Erixon, & Archer, 2000; Ruble et al, 2006).

Children’s gender schemas can be modified to be less stereotypical. Adults should thus assist children to be accepting of themselves, and focus less on gender stereotypes and more on activities and occupations that children are interested in.

Knowledge Check

1

Question 1

Please select the correct statement.

  

Self-impaired   concepts often lead to dissatisfaction with gender norms and homosexuality.

 

Sexual   orientation and gender stereotypes are biologically determined.

 

Gender   stereotyping may make girls feel like it is not desirable to be assertive and   independent.

 

Androgyny   is when someone has both male and female sex organs.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Conclusion

This lesson looked at peer interactions, friendship and gender. We firstly looked at how peer interactions develop from infancy to adolescence, and the crucial importance of self-esteem and social skills in peer acceptance. We also looked at the impact of peer acceptance on self-esteem, and how support from adults can help children improve their social skills. Thereafter, we explored friendship, and its characteristics over development. We also discussed the dominance hierarchy of groups, and teenage romance. In the next section of the lesson, we looked at gender. We focused on gender stereotypes and the impact on children’s emotional, intellectual and occupational development. The biological, cognitive and social influences on gender stereotyping were covered. The lesson ended by investigating how children’s sexual orientation may develop, and the benefits of developing more androgynous qualities in children.

KEY TERMS

References

Bagwell, C. L. (2004). Friendships, peer networks and antisocial behavior. In J. B. Kupersmidt & K. A. Dodge (Eds.), Children’s peer relations (pp. 37–57). Washington, DC: American Psychological Association.

Bailey, J. M., Pillard, R. C., Neale, M. C., & Agyei, Y. (1993). Heritable factors influence sexual orientation in women. Archives of General Psychiatry, 50, 217–223.

Bem, S. L. (1981). Gender schema theory: A cognitive account of sex typing. Psychological Review, 88, 354–364.

Bem, S. L. (1998). An unconventional family. New Haven, CT: Yale University Press.

Benenson, J. F., & Christakos, A. (2003). The greater fragility of females’ versus males’ closest same-sex friendships. Child Development, 74, 1123–1129.

Bienert, H., & Schneider, B. H. (1995). Deficit-specific social skills training with peer-nominated aggressive-disruptive and sensitive-isolated preadolescents. Journal of Clinical Child Psychology, 24, 287–299.

Bierman, K. L., Smoot, D. L., & Aumiller, K. (1993). Characteristics of aggressive-rejected, aggressive (nonrejected), and rejected (nonaggressive) boys. Child Development, 64, 139–151.

Bigelow, B. J. (1977). Children’s friendship expectations: A cognitive-developmental study. Child Development, 48, 246–253.

Bigelow, B. J., & LaGaipa, J. J. (1975). Children’s written descriptions of friendship: A multidimensional analysis. Developmental Psychology, 11, 857–858.

Block, J. H. (1983). Differential premises arising from differential socialization of the sexes: Some conjectures. Child Development, 54, 1335–1354.

Brown, E., & Brownell, C. A. (1990). Individual differences in toddlers’ interaction styles. Paper presented at International Conference on Infant Studies, Montreal, Canada.

Burn, S. M., O’Neil, A. K., & Nederend, S. (1996). Childhood tomboyism and adult androgyny. Sex Roles, 34, 419–428.

Casiglia, A. C., Lo Coco, A., & Zappulla, C. (1998). Aspects of social reputation and peer relationships in Italian children: A cross-cultural perspective. Developmental Psychology, 34, 723–730.

Chen, X., Chang, L., & He, Y. (2003). The peer group as context: Mediating and moderating effects on relations between academic achievement and social functioning in Chinese children. Child Development, 74, 710–727.

Cherney, I. D., & London, K. (2006). Gender-linked differences in toys, television shows, computer games, and outdoor activities of 5- to 13-year-old children. Sex Roles, 54, 717–726.

Clark, K. E., & Ladd, G. W. (2000). Connectedness and autonomy support in parent-child relationships: Links to children’s socioemotional orientation and peer relationships. Developmental Psychology, 36, 485–498.

Coie, J. D., & Dodge, K. A. (1983). Continuities and changes in children’s social status: A five-year longitudinal study. Merrill-Palmer Quarterly, 29, 261–282.

Conduct Problems Prevention Research Group. (2004). The Fast Track experiment: Translating the developmental model into a prevention design. In J. B. Kupersmidt & K. A. Dodge (Eds.) Children’s peer relations: From development to intervention (pp. 181–208). Washington, DC: American Psychological Association.

Cowan, C. P., & Cowan, P. A. (2000). When partners become parents: The big life change for couples. Mahwah, NJ: Erlbaum.

Crick, N. R., & Dodge, K. A. (1994). A review and reformulation of social information processing mechanisms in children’s social adjustment. Psychological Bulletin, 115, 74–101.

DeLisi, R., & McGillicuddy-DeLisi, A. V. (2002). Sex differences in mathematical abilities and achievement. In A. V. McGillicuddy & R. DeLisi (Eds.), Biology, society and behavior: The development of sex differences in cognition (pp. 155–182). Westport, CT: Ablex.

DeRosier, M., & Kupersmidt, J. B. (1991). Costa Rican children’s perceptions of their social networks. Developmental Psychology, 27, 656–662.

Dodge, K. A. (1986). A social information processing model of social competence in children. In M. Perlmutter (Ed.), The Minnesota Symposium on Child Psychology: Vol. 18 (pp. 77–125). Hillsdale, NJ: Erlbaum.

Dunn, J. (2004). Children’s friendships. Oxford: Blackwell.

Dweck, C. (2001). Caution—Praise can be dangerous. In K. L. Freiberg (Ed.), Human development 01/02 (9th ed., pp. 105–109). Guilford, CT: Dushkin/McGraw-Hill.

Dweck, C. (2006). Mindset: The new psychology of success. New York, NY: Random House.

Ellis, B. J., Bates, J. E., Dodge, K. A., Fergusson, D. M., Horwood, L. J., Pettit, G. S., et al. (2003). Does father absence place daughters at special risk for early sexual activity and teenage pregnancy? Child Development, 74, 801–821.

Fagot, B. I. (1985a). Beyond the reinforcement principle: Another step toward understanding sex role development. Developmental Psychology, 21, 1097–1104.

French, D. C. (1990). Heterogeneity of peer rejected girls. Child Development, 61, 2028–2031.

Halpern, D. F. (2000). Sex differences in cognitive abilities (3rd ed.). Mahwah, NJ: Erlbaum.

Harter, S. (2006). The self. In W. Damon & R. M. Lerner (Series Eds.), & N. Eisenberg (Vol. Ed.), Handbook of child psychology (6th ed., Vol. 3, pp. 505–570). New York, NY: Wiley.

Hartup, W. W. (1996). The company they keep: Friendships and their developmental significance. Child Development, 67, 1–13.

Hawley, P. H., Johnson, S. E., Mize, J. A., & McNamara, K. A. (2007). Physical attractiveness in preschoolers: Relationships with power, status, aggression and social skills. Journal of School Psychology, 45, 499–521.

Hawley, P. H., & Little, T. D. (1999). On winning some and losing some: A social relations approach to social dominance in toddlers. Merrill-Palmer Quarterly, 45, 188–214.

Hendrick, J., & Stange, T. (1991). Do actions speak louder than words? An effect of the functional use of language on dominant sex role behavior in boys and girls. Early Childhood Research Quarterly, 6, 565–576.

Hetherington, E. M. (1966). Effects of paternal absence on sex-typed behaviors in Negro and white preadolescent males. Journal of Personality and Social Psychology, 4, 87–91.

Hines, M. (2004). Brain gender. New York: Oxford University Press.

Kovacs, D. M., Parker, J. G., & Hoffman, L. W. (1

WEEK 6 FORUM

  

This week, we have discussed issues related to gender and sexuality. You should have some idea of the ways that both biology and society shape our expectations and views of both males and females. Sometimes, however, the issue is not so clear-cut. If you are not familiar with the terms “hermaphrodite” or “intersex,” I suggest that you look them up before participating in this week’s discussion. Then link to and read the following account:
 

www.slate.com/id/2101678/
 

This is obviously a very tragic case on many levels.
 

1.) What does this case tell you about the power of biology?
 

2.) Does it support or refute Dr. Money’s (and others’) apparent view that children are a “blank slate,” and that they can successfully transition from one sex to another if it is done early enough in childhood?
 

3.) Given what happened to David Reimer, what would be your opinion now on whether “sex reassignment surgery” should be done on infants or young children who are born with an intersex condition? Support your argument with empirical research findings. 

READING

Introduction

This lesson will cover peer interactions, friendship and gender. We will begin by exploring how peer interactions develop, and what peer acceptance means in the context of child development. We will investigate how social information-processing functions in popular and unpopular children, and the impact of this on children’s short- and long-term development. We will then move onto friendship, where we will look at what friendship means in the different stages of development. We will look at how groups function, and the importance of teenage romances. We will also look at gender, and the impact of gender stereotypes in child development. We will discuss the role of biology, cognition, family and other social influences on the genders. Lastly, we will have a brief discussion about sexual orientation and androgyny.

Development of Peer Interactions

‹ 1/4 ›

· Early Social Experiences

As we have discussed throughout this course, the home environment has an enormous effect of child development. However, interactions outside the home influence also child development, and the ability to socialize successfully is a cornerstone of development. As the prevalence of preschool education increases, and as more mothers are employed outside the home, children’s ability to socialize at a younger age becomes more significant because of the profound impact social interactions have on a child’s self-esteem. Children’s early social experiences set the foundation for future interactions.

Peer Acceptance

Reinforcement

Children reinforce each other’s behaviors, by ignoring, paying attention to, sharing with, praising and criticizing each other. This ‘peer pressure’ begins from around the age of four, and becomes increasingly powerful as children develop, because being accepted, approved of or ostracized by peers has a tremendous impact on children’s self-esteem.

Social Comparison

Children measure themselves against other children through social comparison, in order to objectively rate and evaluate themselves. How a child is received by peers is highly related to the child’s self-esteem, and defines children’s self-image (Harter, 2006). Positive first experiences can lay the foundation for healthy social behaviors that continue into adulthood.

Sociometric Techniques

Researchers study peer acceptance by measuring each child’s status within peer groups, using sociometric techniques. These measures get the group members to rate each other in characteristics such as aggression, helpfulness and likability (Ladd, 2005).

Popularity

Sociometric techniques have enabled researchers to categorize children’s popularity based on their characteristics and styles of interaction (Bierman, Smoot, & Aumiller, 1993; French, 1990; Ladd, 2005; Parkhurst & Asher, 1992). The nominative technique is a kind of sociometric technique that gets children to select or nominate peers they most like and dislike.

● Popular children receive the most nominations for being well liked, and are prosocial, friendly, good communicators and assertive. However, some popular children have different characteristics. These include being dominant, aggressive, cool, athletic, influential and arrogant.
● Average children do not receive nominations for being well liked or disliked.
● Controversial children receive nominations from being both well liked and disliked.
● Rejected children receive many nominations for being disliked. Aggressive rejected children have behavior problems and little self-control. Nonaggressive rejected children lack social skills, and are withdrawn and anxious.
● Neglected children receive few votes as they are normally friendless and isolated.
We will now look at what drives peers’ judgements of one another.

Social Information-Processing

‹›

· SOCIAL AND COGNITIVE SKILLS

Social and cognitive skills enable children to approach and initiate new social interactions. Socially skilled children want to interact with others. For this to be possible, children need to feel comfortable with others, and this is based on the confidence that they have something useful or valuable to contribute, as well as being interested in finding out about others.

Appearances

Beauty Perceived as Virtue

Although social skills primarily determine children’s social status, there are lesser factors that may contribute. Children and teenagers attribute positive qualities, such as being fearless, friendly, self-sufficient, interpersonally competent and appealing, to people with attractive physical appearances, and attribute negative qualities, such as being aggressive, mean and antisocial, to people with unattractive physical appearances (Hawley, Johnson, Mize, & McNamara, 2007).

Physical Appearance and Treatment

Physically attractive people are treated better, judged more positively and are more popular than unattractive people, and were found to be better adjusted and to have greater intelligence (Langlois et al., 2000). Considering this research in the context of our discussions in previous lessons about the impact of stress, self-esteem and environment factors on cognitive performance, do you think it is possible that an individual’s cognitive performance could be impacted by the way they are treated because of their physical appearance?

Popular Names

Children’s names also have an impact on their social interactions (Rubin, Bukowski, & Parker, 2006). Children with popular names are more acceptable, while children with ‘funny’ names may be less acceptable to their peers. Furthermore, U.S. children generally do not play with children outside their age group, while children from other cultures, such as Africa and Asia, tend to play with children from a far wider range of age groups.

Being Unpopular

 Children can be cruel to those they dislike. Children may exclude, ignore, verbally and physically attack, harass, bully, tease, gossip about and dominate others. Sadly, many rejected children, particularly the nonaggressive ones, are victims of these behaviors.
Unpopular children experience long- and short-term consequences. These include loneliness, social dissatisfaction, alienation and isolation. Academic performance is affected, and these children may avoid or drop out of school. They may be uncooperative and begin to engage in criminal activity. Victimized children may develop depression in early adulthood and be prone to harassment at work. Rejected children usually maintain this status over their lifetime (Coie & Dodge, 1983).

Parents, Teachers, and Peer Acceptance

ATTACHMENT TO PARENTS

ROLE OF ADULTS

SOCIAL COACHING

PROVIDING PLAY OPPORTUNITIES

Watch this video on teaching children social skills at school:

Knowledge Check

1

Question 1

Please select the two correct statements. The most effective ways for adults to help children gain the acceptance of their peers are:

  

To   ensure children have positive social experiences from a young age, especially   within the family.

 

To   train and coach parents and children on social skills.

 

To   ensure the children have the best clothes and toys, and always look great.

 

Peer   acceptance is not that important, therefore adults should not get involved.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Friendship

Hartup (1996) describes friendship as a relationship between equals that includes commitment and reciprocity. Bigelow (1977) and Bigelow and LaGaipa (1975) describe how children’s expectations of friendship progress in three stages. (Please note that the italicized expectations from each stage are carried over to the next stage.)

Friendship tends to develop on the basis of communication, exchanges of information, positive exchanges, common ground, self-disclosure and effective conflict resolution (Parker & Gottman, 1989). Children display more positive affect in interactions with friends, but also disagree more with each other than with nonfriends. Conflicts between friends are usually less heated than with nonfriends, and friends generally try to resolve the conflict in a way that preserves the relationship. While a certain level of conflict in friendship is normal, certain friendships can degenerate into mutual antipathy.

REWARD-COST STAGE

NORMATIVE STAGE

EMPATHETIC STAGE

OLDER CHILDREN

Developmental Stages of Friendship

The goals and processes of friendship change with age.

· PLAY

· PEER ACCEPTANCE

· SELF-UNDERSTANDING

According to Parker and Gottman (1989), until the age of seven, the goal of peer interaction is play, and the processes are geared to facilitate successful play.

Making Friends with or without Keeping Them

An interesting study by Parker and Seal (1996) found that children who make friends easily but do not sustain friendships, know the latest gossip, are ‘playful teasers’, but are also more aggressive, bossy and untrustworthy. However, children who make new friends and sustain friendships are not bossy but are also not pushed around easily.

Intimacy with Few, Isolation from Many

Equally interesting is that the more intimate girl’s friendships are and the more isolated they are from a larger group of friends, the more fragile their relationship is (Benenson & Christakos, 2003). It appears that friendships that are embedded in larger groups may be less fragile because there is more access to alternative partners, allies and third-party mediators. Excessive ‘co-rumination’ between intimate female friends about problems is associated with depression and anxiety, and may intensify problems especially if friends divulge information about their friends to others (Rose, 2002). Boys tend to co-ruminate less, divulge less about their friends to others, and confront their friends directly when there are relationship problems (Rose & Rudolph, 2006).

Benefits of Friendship

Friendship protects against loneliness and depression by providing guidance, support and intimacy. Children with friends have better long-term outcomes. However, some friendships pose risks. Rejected and aggressive children may befriend each other, which often results in unsympathetic, conflictual relationships, as well as deviant behaviors like substance abuse, cheating and aggression (Bagwell, 2004; Poulin, Dishion, & Haas, 1999).

Groups

Dominance Hierarchy

Being part of a group is associated with increased well-being and healthier stress management. Groups always have a dominance hierarchy, which is evident in children as young as two (Hawley & Little, 1999). Hierarchy is established within the first 45 minutes of contact (Pettit, Bakshi, Dodge, & Coie, 1990). Hierarchy promotes social organization and regulation, whereby nonaggressive conflict resolution is orchestrated by higher ranking members, tasks are divided and lower ranking members are allocated working roles and higher ranking members assume leadership roles, and resources are allocated.

Culture

Culture plays a role in the characteristics of peer groups. For example, Israeli children in rural kibbutzim are found to be more cooperative than children from cities, African American children have more opposite-gender friendships, Japanese and Latino children are more family oriented, and Italian children engage in more disputes and debates with friends but have more stable friendships – perhaps due to the higher tolerance for conflict (Casiglia, Lo Coco, & Zappulla, 1998; deRosier & Kupersmidt, 1991; Kovacs, Parker, & Hoffman, 1996; Schneider, 2000). Chinese children form more cliques based on academic achievement (Chen, et al., 2003).

Romance

Adolescent romance is an important developmental milestone. Nurturant parenting is associated with better quality romantic relationships, while inadequate parenting is associated with more violent, aggressive and destructive romances. We will now briefly highlight three common myths about teenage love affairs, as outlined by Parke and Gauvain (2009).

Click on the buttons below to find the reality:

MYTH 1: THESE RELATIONSHIPS ARE TEMPORARY.

MYTH 2: THESE RELATIONSHIPS ARE INCONSEQUENTIAL.

MYTH 3: ADOLESCENT ROMANTIC RELATIONSHIPS ARE INDICATIVE OF PROBLEM BEHAVIORS.

As adolescents get older, the importance of peer-approval of romantic partners decreases, while the importance of shared values and interests, interdependence, compatibility and personality increase.

Knowledge Check

1

Question 1

Please select the two most accurate depictions of how social relationships develop in children and adolescents.

  

Younger   children have more friends of the same-sex. Adolescents begin to associate   more with members of the opposite sex and have romances.

 

Younger   children start at the bottom of the group hierarchy and as they age, they   work their way up to being dominant group members.

 

The   focus changes from play, to social acceptance, to self-understanding.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Gender

There are obvious differences associated with males and females, including genetics, hormones, tendencies, behaviors including reproduction, appearance, roles, the way they are treated and expectations placed on them. However, there are also many similarities between the genders.

· GENDER TYPING

· GENDER IDENTITY

Children learn to differentiate which behaviors, values and motivations are attributed to males and females in a process called gender typing. Gender typing is based on gender stereotypes which tell us what is expected of and acceptable for each gender. Parents and other people act as agents of gender socializing.

As you watch this video on gender stereotyping, assess how children may be influenced to develop academically and intellectually based on gender typing.

Gender Stereotypes

Gender Roles Similar Worldwide

On the whole, cultures across the globe are consistent with the roles they allocate to each gender. Men are typically expected to be assertive, dominant and competitive, and women are expected to be more passive, sensitive, loving and sociable. While not always helpful in promoting gender equality, these stereotypes have generally tended to stick.

Play Preferences

For instance, research on one-year olds found that girls show preferences for dolls, while boys show preferences for vehicles (Serbin, Poulin-Dubois, Colburne, Sen & Eichstedt, 2001). Moreover, while college educated women are more likely to be advocates of female independence and achievement, men – even well-educated ones, maintain stereotyped gender-role standards, especially of their children.

Stereotypes

Why is this? The male role, particularly in Western culture, is esteemed with greater status and privileges, but is also more clearly defined, thus pressuring males into conforming to certain roles and behaviors. It is thought-provoking to note that it is normally more acceptable for girls to partake in masculine activities, and that when boys partake in feminine activities they are often ridiculed for being ‘sissies’. How do you think this relates to masculinity being ascribed a higher status that femininity?

Interests and Culture

If children’s interests are consistent with cultural standards on what is gender-appropriate, these interests tend to continue into adulthood, however, if they are not consistent, these interests rarely continue into adulthood. Moreover, Cherney and London (2006) found that boys generally develop more intense interests in gender stereotyped activities and events than girls, that last longer in the male lifespan that females’ gender stereotyped interests last.

Tendency to Follow Stereotype

While children, especially girls, may participate to a degree in both male and female pursuits, in adolescence they tend to adhere more strictly to gender stereotypes, perhaps due to increased pressure from peers, parents, other social influencers and their interest in romantic relationships (Burn, O’Neil, & Nederend, 1996). When adults become parents, gender roles also tend to become more defined, where females display expressive characteristics, such as empathy and nurturing the child, while males display more instrumental characteristics, by focusing on occupation and tasks (Cowan & Cowan, 2000).

Knowledge Check

1

Question 1

Please select the correct statement.

  

Children’s   interests and academic path have nothing to do with gender stereotyping.

 

Typical   masculine gender roles emanate from their expressive characteristics.

 

Children   chose their toys based on their gender-role preferences.

 

Gender   typing describes the types of things that are acceptable for each gender.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Biological Differences

· HORMONES

· BRAIN LATERALIZATION

· COGNITIVE FACTORS

Hormones are chemical substances that regulate certain organs, characteristics and functions. As we discussed in the second lesson, the male’s principal hormone is testosterone, and the female’s principal hormones are estrogen and progesterone. These hormones organize the fetus’s biological and psychological predispositions.

There are differences in the genders’ verbal and spatial abilities from a young age, which Hines (2004) attributes to prenatal hormones. For instance, higher androgen (male hormone) levels are associated with better visual-spatial skills. Research has also determined that when girls have more testosterone, they acquire masculine characteristics like being more assertive and enjoying rough physical play (Reiner & Gearhart, 2004).

Family Influences

Parental Influence on Gender-typing

Parents influence their children’s gender-typing and gender-role behaviors by the way they speak to them, treat them, dress them, play with them, the kinds of activities, toys, interactions and opportunities they provide, and by their modeling. From the time children are born, parents focus on their son’s alertness, size, coordination and strength, and on their daughter’s beauty, gentleness and fragility (Stern & Karraker, 1989). Parents play more with their sons, engage more in rough-and-tumble, touch them more, and speak to them in a ‘macho’ way. Boys are encouraged to be independent, and to explore, compete and achieve more (Ruble, Martin, & Berenbaum, 2006).

Sons and Daughters are Treated Differently

Parents teach sons more, but focus more on emotions and interpersonal interactions with daughters (Block, 1983). Parents cuddle girls more, talk to them more, use directive, supportive speech, and are more protective over them (Leaper & Friedman, 2007). They also encourage daughters to be more dependent. Psychologists warn that gender stereotyping is harmful to girls when it promotes helplessness, dependence and reduces their sense of self-efficacy.

Father’s Role

 Fathers are the principal agents of gender-role socialization, and are generally very insistent that children play with gender-specific toys (Parke, 2002). Fathers also focus more on their sons’ than daughters’ careers and achievements in mathematics and science (DeLisi & McGillicuddy-DeLisi, 2002).
If fathers are absent from when children are young, there may be interruptions in gender identity and gender role in sons, but if there are other male models present, this impact can be mitigated (Hetherington, 1966). Girls are more likely to be affected in adolescence. Daughters of absent fathers have more difficulties in relating to males – daughters of divorcees and single mothers are more sexually precocious, and daughters of widows tend to be shy and anxious about sexuality (Ellis et al., 2003).

Homosexual Parents

Children of homosexual parents develop no differently from children of heterosexual parents: gender typing and gender-role behaviors are identical in each situation, and children of homosexual parents are not more likely to develop homosexual orientations (Patterson & Hastings, 2007). Socioemotional development is also similar in these children.

Other Influences

Media Promotes Stereotypes

Media such as books and television promote gender stereotyping. Males are portrayed as stable, rational, competent and tolerant, and desirable female traits are warmth and sociability. There is an increasing proclivity however, to cast women in a wider range of occupational roles and nontraditional gender roles.

Sibling and Peer Influences

Siblings and peers influence and enforce gender-role standards. Fagot (1985) found that preschoolers treat peers harshly when gender norms are violated, by heckling, ignoring and criticizing them. From preschool until children reach puberty, children primarily associate with the same gender. This is referred to as gender segregation, and in this period, children engage in stereotyped gender activities where boys are active and play rough, while girls are less active and less competitive. Furthermore, girls are boys do not interact much because boys prefer direct demands whereas girls prefer polite requests (Maccoby, 1998).

Schools and Teachers

Schools and teachers send strong signals to children about gender norms. The classroom favors girls because of their verbal orientation and less boisterous, rule-following behaviors. Girls generally enjoy school more, especially in the early grades, and boys struggle to adapt and perform as well as girls, particularly in reading (Halpern, 2000; McCall, Beach, & Lan, 2000).

However, girls’ achievements decline, and by college, girls tend to underachieve more than boys (Wigfield, Eccles, & Schiefele, 2006). Dweck (2001, 2006) attributes this to the detrimental effect of gender stereotyping that influences girls to be less independent thinkers who are less capable of assertive, creative problem-solving. Public achievement for girls is controversial in some circles, and girls may hide their abilities and achievements, especially from boys (Ruble et al. 2006). Even women who have successful careers may underplay their success, be afraid to be assertive or competitive, and have a ‘super-feminine’ appearance.

Teachers promote gender-specific behavior in the classroom, by interrupting girls more, paying more attention to boys’ assertive behaviors than to girls’, and responding more to girls’ social overtures (Hendrick & Stange, 1991). Boys are encouraged more in mathematics, and girls more in literature, and by high school girls are more likely to drop math (Shea, Lubinski, & Benbow, 2001).

Sexual Orientation

ADOLESCENTS

PREDICTORS OF ACCEPTANCE

INFLUENCES

Androgyny

It has been argued that gender stereotyping is psychologically and socially damaging, especially since we know that most people have a combination of male and female attributes – both genders can be fiercely competitive and nurturing, and both genders can excel at activities like sewing, cooking, carpentry and business management.

Androgynous children have masculine and feminine psychological attributes, and are less likely to make stereotyped choices (Bem, 1981, 1998). Research has found that masculine and androgynous children have higher self-esteem than feminine children and are more creative and well-adjusted (Norlander, Erixon, & Archer, 2000; Ruble et al, 2006).

Children’s gender schemas can be modified to be less stereotypical. Adults should thus assist children to be accepting of themselves, and focus less on gender stereotypes and more on activities and occupations that children are interested in.

Knowledge Check

1

Question 1

Please select the correct statement.

  

Self-impaired   concepts often lead to dissatisfaction with gender norms and homosexuality.

 

Sexual   orientation and gender stereotypes are biologically determined.

 

Gender   stereotyping may make girls feel like it is not desirable to be assertive and   independent.

 

Androgyny   is when someone has both male and female sex organs.

I don’t know

One attempt

Submit answer

You answered 0 out of 0 correctly. Asking up to 1.

Conclusion

This lesson looked at peer interactions, friendship and gender. We firstly looked at how peer interactions develop from infancy to adolescence, and the crucial importance of self-esteem and social skills in peer acceptance. We also looked at the impact of peer acceptance on self-esteem, and how support from adults can help children improve their social skills. Thereafter, we explored friendship, and its characteristics over development. We also discussed the dominance hierarchy of groups, and teenage romance. In the next section of the lesson, we looked at gender. We focused on gender stereotypes and the impact on children’s emotional, intellectual and occupational development. The biological, cognitive and social influences on gender stereotyping were covered. The lesson ended by investigating how children’s sexual orientation may develop, and the benefits of developing more androgynous qualities in children.

KEY TERMS

References

Bagwell, C. L. (2004). Friendships, peer networks and antisocial behavior. In J. B. Kupersmidt & K. A. Dodge (Eds.), Children’s peer relations (pp. 37–57). Washington, DC: American Psychological Association.

Bailey, J. M., Pillard, R. C., Neale, M. C., & Agyei, Y. (1993). Heritable factors influence sexual orientation in women. Archives of General Psychiatry, 50, 217–223.

Bem, S. L. (1981). Gender schema theory: A cognitive account of sex typing. Psychological Review, 88, 354–364.

Bem, S. L. (1998). An unconventional family. New Haven, CT: Yale University Press.

Benenson, J. F., & Christakos, A. (2003). The greater fragility of females’ versus males’ closest same-sex friendships. Child Development, 74, 1123–1129.

Bienert, H., & Schneider, B. H. (1995). Deficit-specific social skills training with peer-nominated aggressive-disruptive and sensitive-isolated preadolescents. Journal of Clinical Child Psychology, 24, 287–299.

Bierman, K. L., Smoot, D. L., & Aumiller, K. (1993). Characteristics of aggressive-rejected, aggressive (nonrejected), and rejected (nonaggressive) boys. Child Development, 64, 139–151.

Bigelow, B. J. (1977). Children’s friendship expectations: A cognitive-developmental study. Child Development, 48, 246–253.

Bigelow, B. J., & LaGaipa, J. J. (1975). Children’s written descriptions of friendship: A multidimensional analysis. Developmental Psychology, 11, 857–858.

Block, J. H. (1983). Differential premises arising from differential socialization of the sexes: Some conjectures. Child Development, 54, 1335–1354.

Brown, E., & Brownell, C. A. (1990). Individual differences in toddlers’ interaction styles. Paper presented at International Conference on Infant Studies, Montreal, Canada.

Burn, S. M., O’Neil, A. K., & Nederend, S. (1996). Childhood tomboyism and adult androgyny. Sex Roles, 34, 419–428.

Casiglia, A. C., Lo Coco, A., & Zappulla, C. (1998). Aspects of social reputation and peer relationships in Italian children: A cross-cultural perspective. Developmental Psychology, 34, 723–730.

Chen, X., Chang, L., & He, Y. (2003). The peer group as context: Mediating and moderating effects on relations between academic achievement and social functioning in Chinese children. Child Development, 74, 710–727.

Cherney, I. D., & London, K. (2006). Gender-linked differences in toys, television shows, computer games, and outdoor activities of 5- to 13-year-old children. Sex Roles, 54, 717–726.

Clark, K. E., & Ladd, G. W. (2000). Connectedness and autonomy support in parent-child relationships: Links to children’s socioemotional orientation and peer relationships. Developmental Psychology, 36, 485–498.

Coie, J. D., & Dodge, K. A. (1983). Continuities and changes in children’s social status: A five-year longitudinal study. Merrill-Palmer Quarterly, 29, 261–282.

Conduct Problems Prevention Research Group. (2004). The Fast Track experiment: Translating the developmental model into a prevention design. In J. B. Kupersmidt & K. A. Dodge (Eds.) Children’s peer relations: From development to intervention (pp. 181–208). Washington, DC: American Psychological Association.

Cowan, C. P., & Cowan, P. A. (2000). When partners become parents: The big life change for couples. Mahwah, NJ: Erlbaum.

Crick, N. R., & Dodge, K. A. (1994). A review and reformulation of social information processing mechanisms in children’s social adjustment. Psychological Bulletin, 115, 74–101.

DeLisi, R., & McGillicuddy-DeLisi, A. V. (2002). Sex differences in mathematical abilities and achievement. In A. V. McGillicuddy & R. DeLisi (Eds.), Biology, society and behavior: The development of sex differences in cognition (pp. 155–182). Westport, CT: Ablex.

DeRosier, M., & Kupersmidt, J. B. (1991). Costa Rican children’s perceptions of their social networks. Developmental Psychology, 27, 656–662.

Dodge, K. A. (1986). A social information processing model of social competence in children. In M. Perlmutter (Ed.), The Minnesota Symposium on Child Psychology: Vol. 18 (pp. 77–125). Hillsdale, NJ: Erlbaum.

Dunn, J. (2004). Children’s friendships. Oxford: Blackwell.

Dweck, C. (2001). Caution—Praise can be dangerous. In K. L. Freiberg (Ed.), Human development 01/02 (9th ed., pp. 105–109). Guilford, CT: Dushkin/McGraw-Hill.

Dweck, C. (2006). Mindset: The new psychology of success. New York, NY: Random House.

Ellis, B. J., Bates, J. E., Dodge, K. A., Fergusson, D. M., Horwood, L. J., Pettit, G. S., et al. (2003). Does father absence place daughters at special risk for early sexual activity and teenage pregnancy? Child Development, 74, 801–821.

Fagot, B. I. (1985a). Beyond the reinforcement principle: Another step toward understanding sex role development. Developmental Psychology, 21, 1097–1104.

French, D. C. (1990). Heterogeneity of peer rejected girls. Child Development, 61, 2028–2031.

Halpern, D. F. (2000). Sex differences in cognitive abilities (3rd ed.). Mahwah, NJ: Erlbaum.

Harter, S. (2006). The self. In W. Damon & R. M. Lerner (Series Eds.), & N. Eisenberg (Vol. Ed.), Handbook of child psychology (6th ed., Vol. 3, pp. 505–570). New York, NY: Wiley.

Hartup, W. W. (1996). The company they keep: Friendships and their developmental significance. Child Development, 67, 1–13.

Hawley, P. H., Johnson, S. E., Mize, J. A., & McNamara, K. A. (2007). Physical attractiveness in preschoolers: Relationships with power, status, aggression and social skills. Journal of School Psychology, 45, 499–521.

Hawley, P. H., & Little, T. D. (1999). On winning some and losing some: A social relations approach to social dominance in toddlers. Merrill-Palmer Quarterly, 45, 188–214.

Hendrick, J., & Stange, T. (1991). Do actions speak louder than words? An effect of the functional use of language on dominant sex role behavior in boys and girls. Early Childhood Research Quarterly, 6, 565–576.

Hetherington, E. M. (1966). Effects of paternal absence on sex-typed behaviors in Negro and white preadolescent males. Journal of Personality and Social Psychology, 4, 87–91.

Hines, M. (2004). Brain gender. New York: Oxford University Press.

Kovacs, D. M., Parker, J. G., & Hoffman, L. W. (1

NURS 6630 Final Exam (2018), NURS 6630 Midterm Exam (2018): Walden University (Already graded A)

  

                                    NURS6630 Final Exam (2018): Walden University

QUESTION 1 

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? 

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs 

QUESTION 2 

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? 

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics 

QUESTION 3 

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? 

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above. 

QUESTION 4 

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? 

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent. 

QUESTION 5 

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? 

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy 

QUESTION 6 

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax) 

QUESTION 7 

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? 

A. Strattera B. Concerta C. Daytrana D. Adderall 

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? 

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient 

QUESTION 9 

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient? 

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency. 

QUESTION 10 

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? 

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. 

QUESTION 11 

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? 

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.” 

QUESTION 12 

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? 

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. 

QUESTION 13 

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: 

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. 

QUESTION 14 

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? 

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue. 

QUESTION 15 

Which patient will receive a lower dose of guanfacine? 

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease 

QUESTION 16 

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? 

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain 

QUESTION 17 

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? 

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool. 

QUESTION 18 

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? 

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime 

QUESTION 19 

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands? 

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness. 

QUESTION 20 

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? 

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg 

QUESTION 21 

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? 

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. 

QUESTION 22 

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? 

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. 

QUESTION 23 

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? 

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. 

QUESTION 24 

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID 

QUESTION 25 

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? 

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” 

QUESTION 26 

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? 

Venlafaxine (Effexor) 

Duloxetine (Cymbalta) 

Clozapine (Clozaril) 

Phenytoin (Dilantin) 

QUESTION 27 

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? 

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain. 

QUESTION 28 

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above 

QUESTION 29 

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin 

QUESTION 30 

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? 

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera) 

QUESTION 31 

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? 

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C 

QUESTION 32 

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? 

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above 

QUESTION 33 

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? 

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” 

QUESTION 34 

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? 

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone 

QUESTION 35 

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? 

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” 

QUESTION 36 

Which statement best describes a pharmacological approach to treating patients for impulsive aggression? 

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive. 

QUESTION 37 

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? 

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things. 

QUESTION 38 

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? 

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” 

QUESTION 39 

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? 

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption. 

QUESTION 40 

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? 

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine 

QUESTION 41 

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? 

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above 

QUESTION 42 

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? 

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly. 

QUESTION 43 

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? 

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics 

QUESTION 44 

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe? 

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien) 

QUESTION 45 

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make? 

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) 

QUESTION 46 

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? 

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.” 

QUESTION 47 

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? 

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above 

QUESTION 48 

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? 

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.” 

QUESTION 49 

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? 

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms. 

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? 

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac) 

QUESTION 51 

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? 

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin) 

QUESTION 52 

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? 

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera) 

QUESTION 53 

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? 

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above. 

QUESTION 54 

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? 

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. 

QUESTION 55 

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? 

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions. 

QUESTION 56 

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? 

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD. 

QUESTION 57 

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? 

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only 

QUESTION 58 

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: 

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia 

QUESTION 59 

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? 

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil 

QUESTION 60 

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? 

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.” 

QUESTION 61 

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? 

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B” 

QUESTION 62 

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? 

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above 

QUESTION 63 

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment. 

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil. 

QUESTION 64 

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? 

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro) 

QUESTION 65 

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? 

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.” 

QUESTION 66 

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems? 

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above 

QUESTION 67 

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? 

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine. 

QUESTION 68 

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions? 

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal 

QUESTION 69 

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? 

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres) 

QUESTION 70 

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? 

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA. 

QUESTION 71 

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed

NURS 6630 Final Exam (2018), NURS 6630 Midterm Exam (2018): Walden University (Already graded A)

  

                                    NURS6630 Final Exam (2018): Walden University

QUESTION 1 

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? 

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs 

QUESTION 2 

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? 

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics 

QUESTION 3 

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? 

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above. 

QUESTION 4 

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? 

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent. 

QUESTION 5 

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? 

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy 

QUESTION 6 

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax) 

QUESTION 7 

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? 

A. Strattera B. Concerta C. Daytrana D. Adderall 

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? 

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient 

QUESTION 9 

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient? 

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency. 

QUESTION 10 

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? 

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. 

QUESTION 11 

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? 

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.” 

QUESTION 12 

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? 

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. 

QUESTION 13 

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: 

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. 

QUESTION 14 

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? 

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue. 

QUESTION 15 

Which patient will receive a lower dose of guanfacine? 

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease 

QUESTION 16 

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? 

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain 

QUESTION 17 

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? 

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool. 

QUESTION 18 

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? 

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime 

QUESTION 19 

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands? 

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness. 

QUESTION 20 

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? 

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg 

QUESTION 21 

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? 

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. 

QUESTION 22 

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? 

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. 

QUESTION 23 

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? 

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. 

QUESTION 24 

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID 

QUESTION 25 

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? 

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” 

QUESTION 26 

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? 

Venlafaxine (Effexor) 

Duloxetine (Cymbalta) 

Clozapine (Clozaril) 

Phenytoin (Dilantin) 

QUESTION 27 

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? 

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain. 

QUESTION 28 

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above 

QUESTION 29 

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin 

QUESTION 30 

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? 

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera) 

QUESTION 31 

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? 

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C 

QUESTION 32 

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? 

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above 

QUESTION 33 

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? 

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” 

QUESTION 34 

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? 

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone 

QUESTION 35 

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? 

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” 

QUESTION 36 

Which statement best describes a pharmacological approach to treating patients for impulsive aggression? 

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive. 

QUESTION 37 

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? 

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things. 

QUESTION 38 

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? 

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” 

QUESTION 39 

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? 

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption. 

QUESTION 40 

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? 

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine 

QUESTION 41 

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? 

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above 

QUESTION 42 

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? 

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly. 

QUESTION 43 

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? 

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics 

QUESTION 44 

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe? 

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien) 

QUESTION 45 

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make? 

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) 

QUESTION 46 

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? 

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.” 

QUESTION 47 

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? 

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above 

QUESTION 48 

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? 

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.” 

QUESTION 49 

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? 

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms. 

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? 

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac) 

QUESTION 51 

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? 

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin) 

QUESTION 52 

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? 

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera) 

QUESTION 53 

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? 

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above. 

QUESTION 54 

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? 

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. 

QUESTION 55 

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? 

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions. 

QUESTION 56 

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? 

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD. 

QUESTION 57 

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? 

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only 

QUESTION 58 

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: 

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia 

QUESTION 59 

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? 

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil 

QUESTION 60 

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? 

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.” 

QUESTION 61 

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? 

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B” 

QUESTION 62 

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? 

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above 

QUESTION 63 

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment. 

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil. 

QUESTION 64 

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? 

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro) 

QUESTION 65 

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? 

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.” 

QUESTION 66 

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems? 

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above 

QUESTION 67 

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? 

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine. 

QUESTION 68 

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions? 

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal 

QUESTION 69 

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? 

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres) 

QUESTION 70 

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? 

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA. 

QUESTION 71 

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed

NURS 6630 Final Exam (2018), NURS 6630 Midterm Exam (2018): Walden University (Already graded A)

  

                                    NURS6630 Final Exam (2018): Walden University

QUESTION 1 

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? 

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs 

QUESTION 2 

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? 

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics 

QUESTION 3 

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? 

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above. 

QUESTION 4 

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? 

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent. 

QUESTION 5 

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? 

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy 

QUESTION 6 

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax) 

QUESTION 7 

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? 

A. Strattera B. Concerta C. Daytrana D. Adderall 

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? 

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient 

QUESTION 9 

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient? 

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency. 

QUESTION 10 

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? 

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. 

QUESTION 11 

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? 

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.” 

QUESTION 12 

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? 

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. 

QUESTION 13 

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: 

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. 

QUESTION 14 

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? 

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue. 

QUESTION 15 

Which patient will receive a lower dose of guanfacine? 

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease 

QUESTION 16 

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? 

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain 

QUESTION 17 

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? 

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool. 

QUESTION 18 

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? 

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime 

QUESTION 19 

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands? 

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness. 

QUESTION 20 

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? 

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg 

QUESTION 21 

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? 

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. 

QUESTION 22 

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? 

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. 

QUESTION 23 

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? 

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. 

QUESTION 24 

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID 

QUESTION 25 

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? 

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” 

QUESTION 26 

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? 

Venlafaxine (Effexor) 

Duloxetine (Cymbalta) 

Clozapine (Clozaril) 

Phenytoin (Dilantin) 

QUESTION 27 

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? 

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain. 

QUESTION 28 

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above 

QUESTION 29 

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin 

QUESTION 30 

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? 

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera) 

QUESTION 31 

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? 

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C 

QUESTION 32 

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? 

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above 

QUESTION 33 

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? 

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” 

QUESTION 34 

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? 

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone 

QUESTION 35 

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? 

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” 

QUESTION 36 

Which statement best describes a pharmacological approach to treating patients for impulsive aggression? 

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive. 

QUESTION 37 

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? 

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things. 

QUESTION 38 

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? 

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” 

QUESTION 39 

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? 

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption. 

QUESTION 40 

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? 

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine 

QUESTION 41 

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? 

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above 

QUESTION 42 

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? 

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly. 

QUESTION 43 

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? 

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics 

QUESTION 44 

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe? 

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien) 

QUESTION 45 

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make? 

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) 

QUESTION 46 

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? 

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.” 

QUESTION 47 

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? 

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above 

QUESTION 48 

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? 

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.” 

QUESTION 49 

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? 

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms. 

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? 

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac) 

QUESTION 51 

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? 

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin) 

QUESTION 52 

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? 

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera) 

QUESTION 53 

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? 

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above. 

QUESTION 54 

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? 

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. 

QUESTION 55 

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? 

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions. 

QUESTION 56 

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? 

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD. 

QUESTION 57 

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? 

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only 

QUESTION 58 

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: 

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia 

QUESTION 59 

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? 

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil 

QUESTION 60 

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? 

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.” 

QUESTION 61 

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? 

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B” 

QUESTION 62 

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? 

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above 

QUESTION 63 

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment. 

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil. 

QUESTION 64 

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? 

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro) 

QUESTION 65 

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? 

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.” 

QUESTION 66 

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems? 

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above 

QUESTION 67 

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? 

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine. 

QUESTION 68 

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions? 

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal 

QUESTION 69 

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? 

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres) 

QUESTION 70 

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? 

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA. 

QUESTION 71 

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed

NURS 6630 Final Exam (2018), NURS 6630 Midterm Exam (2018): Walden University (Already graded A)

  

                                    NURS6630 Final Exam (2018): Walden University

QUESTION 1 

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? 

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs 

QUESTION 2 

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? 

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics 

QUESTION 3 

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? 

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above. 

QUESTION 4 

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? 

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent. 

QUESTION 5 

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? 

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy 

QUESTION 6 

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax) 

QUESTION 7 

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? 

A. Strattera B. Concerta C. Daytrana D. Adderall 

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? 

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient 

QUESTION 9 

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient? 

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency. 

QUESTION 10 

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? 

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. 

QUESTION 11 

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? 

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.” 

QUESTION 12 

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? 

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. 

QUESTION 13 

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: 

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. 

QUESTION 14 

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? 

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue. 

QUESTION 15 

Which patient will receive a lower dose of guanfacine? 

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease 

QUESTION 16 

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? 

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain 

QUESTION 17 

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? 

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool. 

QUESTION 18 

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? 

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime 

QUESTION 19 

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands? 

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness. 

QUESTION 20 

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? 

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg 

QUESTION 21 

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? 

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. 

QUESTION 22 

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? 

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. 

QUESTION 23 

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? 

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. 

QUESTION 24 

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID 

QUESTION 25 

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? 

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” 

QUESTION 26 

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? 

Venlafaxine (Effexor) 

Duloxetine (Cymbalta) 

Clozapine (Clozaril) 

Phenytoin (Dilantin) 

QUESTION 27 

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? 

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain. 

QUESTION 28 

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above 

QUESTION 29 

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin 

QUESTION 30 

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? 

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera) 

QUESTION 31 

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? 

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C 

QUESTION 32 

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? 

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above 

QUESTION 33 

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? 

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” 

QUESTION 34 

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? 

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone 

QUESTION 35 

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? 

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” 

QUESTION 36 

Which statement best describes a pharmacological approach to treating patients for impulsive aggression? 

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive. 

QUESTION 37 

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? 

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things. 

QUESTION 38 

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? 

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” 

QUESTION 39 

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? 

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption. 

QUESTION 40 

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? 

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine 

QUESTION 41 

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? 

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above 

QUESTION 42 

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? 

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly. 

QUESTION 43 

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? 

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics 

QUESTION 44 

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe? 

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien) 

QUESTION 45 

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make? 

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) 

QUESTION 46 

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? 

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.” 

QUESTION 47 

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? 

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above 

QUESTION 48 

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? 

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.” 

QUESTION 49 

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? 

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms. 

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? 

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac) 

QUESTION 51 

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? 

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin) 

QUESTION 52 

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? 

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera) 

QUESTION 53 

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? 

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above. 

QUESTION 54 

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? 

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. 

QUESTION 55 

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? 

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions. 

QUESTION 56 

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? 

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD. 

QUESTION 57 

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? 

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only 

QUESTION 58 

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: 

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia 

QUESTION 59 

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? 

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil 

QUESTION 60 

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? 

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.” 

QUESTION 61 

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? 

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B” 

QUESTION 62 

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? 

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above 

QUESTION 63 

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment. 

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil. 

QUESTION 64 

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? 

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro) 

QUESTION 65 

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? 

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.” 

QUESTION 66 

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems? 

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above 

QUESTION 67 

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? 

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine. 

QUESTION 68 

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions? 

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal 

QUESTION 69 

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? 

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres) 

QUESTION 70 

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? 

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA. 

QUESTION 71 

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed

NURS 6630 Final Exam (2018), NURS 6630 Midterm Exam (2018): Walden University (Already graded A)

  

                                    NURS6630 Final Exam (2018): Walden University

QUESTION 1 

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? 

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs 

QUESTION 2 

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? 

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics 

QUESTION 3 

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? 

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above. 

QUESTION 4 

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? 

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent. 

QUESTION 5 

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? 

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy 

QUESTION 6 

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax) 

QUESTION 7 

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? 

A. Strattera B. Concerta C. Daytrana D. Adderall 

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? 

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient 

QUESTION 9 

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient? 

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency. 

QUESTION 10 

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? 

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. 

QUESTION 11 

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? 

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.” 

QUESTION 12 

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? 

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. 

QUESTION 13 

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: 

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. 

QUESTION 14 

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? 

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue. 

QUESTION 15 

Which patient will receive a lower dose of guanfacine? 

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease 

QUESTION 16 

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? 

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain 

QUESTION 17 

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? 

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool. 

QUESTION 18 

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? 

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime 

QUESTION 19 

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands? 

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness. 

QUESTION 20 

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? 

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg 

QUESTION 21 

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? 

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. 

QUESTION 22 

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? 

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. 

QUESTION 23 

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? 

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. 

QUESTION 24 

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID 

QUESTION 25 

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? 

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” 

QUESTION 26 

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? 

Venlafaxine (Effexor) 

Duloxetine (Cymbalta) 

Clozapine (Clozaril) 

Phenytoin (Dilantin) 

QUESTION 27 

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? 

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain. 

QUESTION 28 

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above 

QUESTION 29 

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin 

QUESTION 30 

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? 

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera) 

QUESTION 31 

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? 

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C 

QUESTION 32 

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? 

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above 

QUESTION 33 

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? 

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” 

QUESTION 34 

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? 

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone 

QUESTION 35 

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? 

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” 

QUESTION 36 

Which statement best describes a pharmacological approach to treating patients for impulsive aggression? 

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive. 

QUESTION 37 

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? 

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things. 

QUESTION 38 

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? 

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” 

QUESTION 39 

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? 

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption. 

QUESTION 40 

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? 

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine 

QUESTION 41 

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? 

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above 

QUESTION 42 

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? 

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly. 

QUESTION 43 

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? 

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics 

QUESTION 44 

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe? 

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien) 

QUESTION 45 

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make? 

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) 

QUESTION 46 

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? 

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.” 

QUESTION 47 

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? 

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above 

QUESTION 48 

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? 

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.” 

QUESTION 49 

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? 

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms. 

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? 

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac) 

QUESTION 51 

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? 

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin) 

QUESTION 52 

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? 

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera) 

QUESTION 53 

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? 

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above. 

QUESTION 54 

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? 

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. 

QUESTION 55 

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? 

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions. 

QUESTION 56 

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? 

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD. 

QUESTION 57 

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? 

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only 

QUESTION 58 

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: 

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia 

QUESTION 59 

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? 

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil 

QUESTION 60 

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? 

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.” 

QUESTION 61 

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? 

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B” 

QUESTION 62 

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? 

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above 

QUESTION 63 

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment. 

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil. 

QUESTION 64 

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? 

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro) 

QUESTION 65 

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? 

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.” 

QUESTION 66 

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems? 

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above 

QUESTION 67 

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? 

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine. 

QUESTION 68 

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions? 

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal 

QUESTION 69 

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? 

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres) 

QUESTION 70 

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? 

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA. 

QUESTION 71 

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed

NURS 6630 Final Exam (2018), NURS 6630 Midterm Exam (2018): Walden University (Already graded A)

  

                                    NURS6630 Final Exam (2018): Walden University

QUESTION 1 

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? 

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs 

QUESTION 2 

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? 

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics 

QUESTION 3 

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? 

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above. 

QUESTION 4 

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? 

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent. 

QUESTION 5 

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient? 

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy 

QUESTION 6 

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax) 

QUESTION 7 

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe? 

A. Strattera B. Concerta C. Daytrana D. Adderall 

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? 

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient 

QUESTION 9 

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient? 

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency. 

QUESTION 10 

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? 

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. 

QUESTION 11 

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly? 

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.” 

QUESTION 12 

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? 

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. 

QUESTION 13 

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: 

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. 

QUESTION 14 

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion? 

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue. 

QUESTION 15 

Which patient will receive a lower dose of guanfacine? 

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease 

QUESTION 16 

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient? 

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain 

QUESTION 17 

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? 

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool. 

QUESTION 18 

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? 

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime 

QUESTION 19 

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands? 

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness. 

QUESTION 20 

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? 

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg 

QUESTION 21 

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? 

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. 

QUESTION 22 

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? 

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. 

QUESTION 23 

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? 

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. 

QUESTION 24 

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID 

QUESTION 25 

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient? 

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” 

QUESTION 26 

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient? 

Venlafaxine (Effexor) 

Duloxetine (Cymbalta) 

Clozapine (Clozaril) 

Phenytoin (Dilantin) 

QUESTION 27 

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work? 

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain. 

QUESTION 28 

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above 

QUESTION 29 

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin 

QUESTION 30 

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? 

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera) 

QUESTION 31 

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? 

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C 

QUESTION 32 

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient? 

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above 

QUESTION 33 

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP? 

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” 

QUESTION 34 

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe? 

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone 

QUESTION 35 

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options? 

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” 

QUESTION 36 

Which statement best describes a pharmacological approach to treating patients for impulsive aggression? 

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive. 

QUESTION 37 

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient? 

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things. 

QUESTION 38 

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders? 

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.” 

QUESTION 39 

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction? 

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption. 

QUESTION 40 

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? 

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine 

QUESTION 41 

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? 

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above 

QUESTION 42 

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? 

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly. 

QUESTION 43 

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? 

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics 

QUESTION 44 

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe? 

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien) 

QUESTION 45 

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make? 

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) 

QUESTION 46 

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP? 

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.” 

QUESTION 47 

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects? 

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above 

QUESTION 48 

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach? 

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.” 

QUESTION 49 

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? 

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms. 

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? 

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac) 

QUESTION 51 

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? 

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin) 

QUESTION 52 

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication? 

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera) 

QUESTION 53 

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? 

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above. 

QUESTION 54 

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? 

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. 

QUESTION 55 

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? 

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions. 

QUESTION 56 

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)? 

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD. 

QUESTION 57 

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD? 

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only 

QUESTION 58 

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms: 

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia 

QUESTION 59 

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? 

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil 

QUESTION 60 

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? 

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.” 

QUESTION 61 

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors? 

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B” 

QUESTION 62 

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? 

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above 

QUESTION 63 

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment. 

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil. 

QUESTION 64 

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? 

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro) 

QUESTION 65 

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff? 

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.” 

QUESTION 66 

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems? 

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above 

QUESTION 67 

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients? 

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine. 

QUESTION 68 

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions? 

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal 

QUESTION 69 

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient? 

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres) 

QUESTION 70 

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following? 

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA. 

QUESTION 71 

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed