NRNP 6670 Week 6 Midterm Exam (100% Correct Collection)/Al... - $28.00 Add To Cart
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NRNP 6670 Week 6 Midterm Exam (100% Correct Fall QTR)/ NRNP/PRAC 6670 Psychiatric Mental Health Nurse Practitioner Role II: Adult And Older Adult 75/75 Gra... [Show More] ded A+ Walden University Question: Sally is a 54-year-old female who presents for care at the urging of her employer. She says that she doesn’t think she needs to be there, but the manager of her division at work strongly … that she make an appointment. She is the evening shift manager in the accounting department of a major online sales organization. Her role requires meticulous accountability of a complex system of production statistics, and she has done this exceedingly well for years. She has been a … employee, and her work is above reproach. A few months ago, the company … a new software program that … a complete revamping of Sally’s department. She has not adapted well, and her resulting anxiety is almost prohibitive of functioning in her role. During her interview, Sally is very somber and serious, and is clearly having difficulty with this change. She is distraught over the potential of not being able to do her job well and meet her immediate supervisor’s expectations. Recognizing the likely diagnosis, the PMHNP knows that Sally is likely to respond best to: 2.Question: Becci is a 31-year-old female who presents to the PMHNP for evaluation after being … by her friend who is a patient of the practice. She describes a relatively acute, recent onset of panic attacks. Becci says that “out of the blue” her heart starts to race, her mouth gets dry, she gets shaky, and feels like she cannot get her breath. She is afraid because her friend has panic disorder and Becci knows that before her friend got treatment, she basically would not leave the house in case an attack happened. The PMHNP recognizes that the immediate priority in assessment for Becci is: 3. Question: Mrs. Bowen is a 33-year-old female who presents as a new patient requesting medication for depression. She reports a long history of mood disorders on and off going back to adolescence. She is very articulate in describing her history and reports that neither sertraline nor fluoxetine “worked for her.” She was unable to remember the dose or how long she took the medication. With respect to considering Mrs. Bowen’s medication history, the PMHNP knows that: 4. Question: Danielle is a 31-year-old female who is having a psychiatric evaluation at the insistence of her husband. They have been … for 4 years, and her husband has finally become so … by her jealous behavior that he threatened to leave her if she didn’t “get help.” Her husband insists that he has never been unfaithful, but Danielle repeatedly accuses him of having an affair. If he is even a few minutes late getting home from work, she demands an explanation and then does not believe anything he says. She does not have any real friends—her sister is her closest social contact, but Danielle has been angry with her for several weeks and won’t answer phone calls. Reportedly she does this often, and according to her husband can “hold a grudge forever.” During the interview, Danielle is calm, responsive, but distant. She says she really doesn’t understand why she is there—there is not a problem. The PMHNP considers the most likely diagnosis and discusses with Danielle that the treatment of choice is: 5. Question: A 22-year-old male patient is … on sertraline 50 mg p.o. daily after presenting with a major depressive episode. After tolerating without difficulty for 2 weeks, his dose is … to 100 mg p.o. daily. Approximately 4 weeks later he reports an unusual set of new symptoms for the last week and a half. He says he feels “amped up” and just very generally agitated and nervous. He was short- tempered at work and home and was snapping at people for no good reason. He also reports difficulty concentrating at work. Last week he expressed disproportionate anger at his work and his boss told him that he was bipolar and should be put on medication. The PMHNP discusses with the patient that: 6. Question: Darius is a 26-year-old male who presents for care as part of couple therapy with his wife, who is being seen for dependency issues. Darius himself seems very anxious to “do the right thing” and appears to want to please the therapist. During the evaluation, Darius is impeccably dressed, very formal in his presentation and interaction, and is watchful of time because he has an appointment after the interview and states several times that he cannot be late. The PMHNP considers that Darius may have obsessive compulsive personality disorder (OCPD). In differentiating this from obsessive compulsive disorder (OCD), she explores his history further for: 7. Question: In documenting a mental status exam (MSE) for Janet, a 54-year-old female, the PMHNP notes that she is bradykinesic, has poverty of speech, is … , and appears flat. This includes all the following elements of physical examination except: 8. Question: When performing a psychiatric assessment of an elderly patient with Alzheimer’s dementia, the PMHNP recognizes that: 9. Question: When differentiating a major depressive episode from dysthymic disorder, the PMHNP considers that: 10. Question: During the interview of Kevin, a 42-year-old male who presents for treatment because of marital problems, the PMHNP responds to his tears by gently moving a box of tissues toward him. This is a facilitating intervention of interview known as: 11. Question: The psychological sciences have … theoretical foundations to the etiology and management of anxiety disorders from both conceptual and practical perspectives. The concept that anxiety develops in persons who feel as though they are living in a world devoid of meaning is an example of which theoretical foundation? 12. Question: Which of the following is a true statement with respect to the treatment of narcissistic personality disorder? 13. Question: Fletcher is a 29-year-old male … for court-ordered counseling. He has a long history of … offenses including DUI, domestic violence, battery, and other violent acts that fortunately have not yet … any serious injury or death to the recipients. An interview with his wife reveals that he has … about almost everything for the last few years; he is able to get … for jobs because he is very engaging and likeable, and then invariably he gets … because he misses work and doesn’t do his job properly when he is there. According to the wife, they have known each other since high school, where Fletcher was very happy and well-adjusted. He was on the soccer team, liked by teachers, and never demonstrated the tendencies he does now. Apparently in college he got … with a fraternity that was notorious for alcohol and drug abuse, and he started drinking heavily; it was “all downhill from there.” The PMHNP considers that: 14. Question: Anne is a 32-year-old female who … to care after a random drug screening at work was positive for cocaine. She was initially resistant to therapy, maintaining that her use is not a problem and she could stop at any time. Upon further discussion in session, it appears that she uses cocaine every day at work, sometimes 2–3 times, other days more. She also uses it occasionally at home and most weekends. During her third session, she … that it is a financial burden, and she basically cannot afford any other form of recreation. She understands that if she uses again she will lose her job, and she admits that she loves her job and that cocaine is not worth losing it. When counseling her about cessation strategies, the PMHNP advises all the following except: 15. Question: Which of the following personality disorders is … with females with fragile X syndrome? 16. Question: Alexa is a 27-year-old female who has come to group therapy while she is in the city jail. She was … for vagrancy because she was sleeping in her car in a parking lot at a local shopping center. She could not post bail, so she is … to 14 days in jail. During group, she contributes that none of this is her fault. Her mother is totally evil because she would not let Alexa stay in the family home. She has some other family. but they are all jerks because they won’t help her. Alexa’s friend Melanie is the absolute best person in the world, but she can’t help because her boss … her for no reason. Alexa has a history of arrests for buying illegal drugs and prostitution. The last time she was in jail, her sentence was … for 30 days because she got into a fight with another inmate and beat her up so badly she had to … to the hospital for 6 days. The PMHNP considers which of the following personality disorders? 17. Question: The professional relationship between therapist and patient with schizoid personality disorder is a challenge because these patients do not typically seek care independently. However, once a trusting relationship develops, this type of patient may: 18. Question: The major defensive mechanisms … by patients with histrionic personality disorder include: 19. Question: Jen is a 31-year-old female who presents for care complaining of … mood. During the interview, it becomes apparent that she has a long history of depressive symptoms, as well as a long history of being socially … and feeling generally inadequate. When considering a diagnosis of dysthymia, the PMHNP considers that the core concept of dysthymia refers to sub-affective or subclinical depressive disorder with all of the following except: 20. Question: Cory is a 23-year-old male recently … in the county correction facility for a 9-month sentence following his third conviction for battery. As part of an early release program, he is … to participate in the therapy program. During his initial interview, he is very pleasant and …, expressing no anxiety or distress with his current circumstances. His psychiatric history is significant for numerous adolescent episodes of running away, truancy, and substance abuse. As a young adult, he reportedly has not held a steady job but rather is constantly coming up with money-making schemes. According to family reports is a personality disorder are very likely to: 21. Question: Assessment of the manic state in a patient with bipolar disorder is likely to include all the following except: 22. Question: From a biological perspective, all of the following neurotransmitters are implicit in the anxiety response except: 23. Question: The International Study of Expert Judgment on Therapeutic Use of Benzodiazepines and Other Psychotherapeutic Medications was … to gather systematic data on the opinions of leading clinicians concerning the benefits and risks of benzodiazepines and alternative anxiety treatments. Which of the following best characterizes the majority opinion of this group? 24. Question: Which of the following is a true statement with regard to the etiology of substance abuse? 25. Question: Marlene is a 35-year-old female who is in therapy primarily to develop coping mechanisms for living with her husband, who has narcissistic personality disorder. She is … to the marriage and loves her husband, but finds his … sense of self-importance and complete lack of empathy to be especially difficult. She believes he has a good side, but most of her friends have only ever seen extreme arrogance, and she is … by that. While counseling Marlene, the PMHNP advises her that patients with narcissistic personality disorder have extremely fragile: 26. Question: Cory J. is a 23-year-old male being seen by the PMHNP today for an initial evaluation. He says that he does not think anything is wrong, but his family, including his mother, grandmother, and aunt, have all told him that he must be “mentally ill.” He has been unable to hold a job and has … as a cook at more than five chain restaurants in the last 6 months. He has no real friends—he says his “friends” only call him when they need something but never help him. He is currently staying with his grandmother but reportedly will soon be homeless “unless things change.” While he is telling his story, the PMHNP appreciates that Cory repeatedly includes details that make it hard to understand his point. When … why he thinks he will be homeless, he responds by talking about how many hours he has … and how everything was going well but then his car broke down and he couldn’t afford to fix it because his tax return was held by the IRS. The PMHNP recognizes that this represents an abnormal: 27. Question: A variety of pharmacologic agents have … effectiveness in the treatment of post-traumatic stress disorder. Which of the following does not have any evidenced-based support in the literature? 28. Question: The PMHNP is on call at the local county correctional facility. He is … to evaluate M.S., a 21-year-old male who was just … following an altercation at a local bar. M.S. has never been … before and apparently has no psychiatric or medical history available. His toxicology screen was negative for alcohol or any drugs of abuse. His mother says that he has in the past had some occasions when he got kind of agitated, but this is the first time it’s been a problem. Reportedly some people from his office were at the bar celebrating a birthday, and before anyone knew what … an argument escalated into M.S. getting very loud, yelling, and acting “crazy” before he punched a coworker and started breaking bottles. When considering a manic or hypomanic episode, the PMHNP expects that his speech would most likely be: 29. Question: The PMHNP is considering pharmacotherapeutic options for Ana, a 28-year-old female with … anxiety disorder. Ana is very … about becoming “addicted” to medication, but she is open to pharmacotherapy because there are a lot of things going on in her life and she worries all the time. Her husband is … overseas, she has just … a new job, and her only child has just … kindergarten. Ana denies any panic-type symptoms; her primary concern is that she is … about everything and it is making it hard to sleep and concentrate on learning the skills for her new job. Ana may best benefit from: 30. Question: The PMHNP is evaluating Jared, a 47-year-old male who is brought to care by his wife because “he’s not the man I … 20 years ago.” According to his wife, she and Jared have been … for 20 years, have two children, and have lived a “normal” life. Jared owns a local construction company and their marriage has been a solid one, … by the typical day-to-day issues that occur in most marriages, but otherwise happy. For the last 2–3 months, she says Jared has completely … He will get angry for no apparent reason and even broke a lamp once. He tells stupid and offensive jokes that no one else thinks are funny, and even had someone call the police when he … to make inappropriate remarks to a woman in a restaurant. Jared seems unsure what to say, but his wife is adamant that this is a totally different man from the one she has known. The PMHNP knows that Jared should … for: 31. Question: Tim is a 20-year-old male who has been … for care by his college counselor. The counselor has … that Tim engages in virtually no social activities in college, and for that matter avoids day-to-day activities that require social interaction. By his own admission, Tim never participates in class discussions, even in online discussion boards. Tim is so afraid of rejection that he confines himself to his room and his studies. When differentiating schizoid personality from avoidant personality, the PMHNP knows that a primary difference is that: 32. Question: Clare’s history of personal relationships is … by complete intolerance of being alone. Whether it is an intimate-partner relationship or a close friend, Clare appears to always need someone in her life. She had a live-in boyfriend of 3 years, and while they were together, he took care of everything. The PMHNP expects all of the following to be additional features of Clare’s history except: 33. Question: The PMHNP is conducting an initial interview with a patient whose history is consistent with avoidant personality disorder. The PMHNP understands that one of the most striking features of this interview is likely to … upon the patient’s: 34. Question: Patients on lithium carbonate for management of bipolar disorder should be subject to routine assessment of: 35. Question: Mr. Henderson is a 69-year-old man who presents for evaluation and care for depression. His wife … 6 months ago following a difficult 2 years with breast cancer. His primary complaint is that he just does not look forward to anything anymore. He cannot get … in his children and grandchildren, he no longer enjoys any of his hobbies because he and his wife … to do them together. He does not sleep well, and wakes up frequently during the night. He also admits to thinking more and more about dying himself, although he expressly denies suicidal ideation. His medical history is significant for coronary artery disease, osteoarthritis, hypothyroidism, hypertension, and dyslipidemia. He also has atrial fibrillation and is on warfarin for emboli prophylaxis, but he does not remember the names of all of his other medications. When considering pharmacotherapy for Mr. Henderson, the PMHNP considers that which of the following SSRIs is safest with respect for potential drug interactions? 36. Question: The PMHNP is … to evaluate the parent of one of her existing patients, a 49-year-old woman … Sheri. Sheri reports that her father, a 78-year-old man who lives alone, has always been in good health. However, when Sheri went to have breakfast with him this past Sunday, she found her father overtly … and he did not even seem to recognize her at first. Sheri is … that he has Alzheimer’s disease, and she is amazed because two days prior he was “completely fine.” The PMHNP knows that the most likely cause of this presentation is: 37. Question: Differentiating post-traumatic stress disorder (PTSD) from panic disorder and … anxiety disorder can be challenging. Which of the following provides the strongest support for PTSD vs the other two differential diagnoses? 38. Question: The PMHNP is seeing a patient who has been … by primary care. The patient was … with major depressive disorder and … on both an SSRI and SNRI by the primary care provider. The patient appears refractory to therapy and has not had any appreciable clinical response. A more … psychiatric history is significant for indicators of bipolar disease, as well as a family history of bipolar disease in both the patient’s father and paternal aunt. This patient will most likely benefit from: 39. Question: John is a 41-year-old male who presents for management of heroin addiction. He has a long history of opiate abuse spanning decades and has had several unsuccessful attempts at recovery. Because of his lifestyle, he has … a variety of chronic health problems, including cardiomyopathy and stage 2 chronic kidney disease. He currently takes several psychiatric medications for mood disorder. When considering methadone maintenance as a mechanism of treating his opiate addiction, the PMHNP knows that if he requires more than 100 mg of methadone at the start of therapy he should have a baseline: 40. Question: Karen is a 19-year-old female who has been … to care after being seen in the emergency department following a violent sexual assault. She was working late one evening at the shopping mall and … alone to her car after dark. She was …, beaten, and thankfully a passerby saw her lying in some bushes and … 911. Initially she was resistant to mental health care, but now, 2 months later, she feels as though she needs help because she is experiencing a collection of symptoms including flashbacks, dreams of the assault, palpitations, anxiety, and a sense that she is watching the assault happen to her This sense of watching the assault as if she was an observer is characteristic of which diagnostic domain of PTSD? 41. Question: Validated and reliable instruments are an important part of assessment for both clinical practice and research in psychiatrics. Which of the following tools is currently … the standard for assessing clinical outcomes in treatment studies of schizophrenia? 42. The PMHNP is working on a graduate program in which he is hoping to develop a new personality assessment tool. After an exhaustive review of the literature and many months of work, he … a tool to use in a research study and needs to establish its psychometric properties. He distributes the tool to four different professionals in the field and asks that they assess whether the questions appear to measure what they are … to measure. This is an assessment of: 43. Question: The difference between a manic and hypomanic episode is best … by all the following except: 44. Question: Which among the following neurotransmitters is … in depression and … in mania? 45. Question: Dependence is a common feature of many psychiatric disorders. One of the primary distinguishing features that differentiates dependent personality disorder from histrionic and borderline personalities is that: 46. Question: Trudy L. is a 29-year-old female patient who … care because she feels like she has no energy. She just had her annual wellness exam and her primary care provider told her that she is in excellent health. Because she … about this excessive fatigue, her PCP …a CBC, CMP, UA and thyroid function tests and was told, along with her physical examination, that everything looks normal. Further discussion reveals that Trudy is having some relationship challenges with her boyfriend of 2 years and this seems to be “spilling over” at work, where she is having persistent conflict with her supervisor. Ultimately the PMHNP diagnoses Trudy with major depressive disorder, mild, single episode. The PMHNP and Trudy discuss treatment options, and Trudy would really like to try nonpharmacologic interventions. Which of the following represents the best approach for Trudy? 47. Question: The PMHNP is considering a diagnosis of paranoid personality disorder in a new patient. When reviewing the history and physical examination, which of the following findings would be most consistent with this diagnosis? 48. Question: The PMHNP is … to the acute care unit to evaluate a patient who is … after being brought in by his friends. They were at a party where there were numerous drugs of abuse as well as alcohol. The patient cannot provide a history, and his friends are unclear as to which drugs he … Physical examination reveals a patient who is diaphoretic, tremulous, has a pulse of 130 bpm, … pupils, and cannot perform fine motor tasks. These physical findings are most consistent with which type of intoxication? 49. Question: Jeffrey T. is a 27-year-old man who has … for care after being … to do so by the county court. He was … in a car accident, and while he was not at fault for the accident, routine blood alcohol screening … that he was driving while …. He is a bit resentful at being required to attend therapy; he is very vocal that his driving was not … and that he is able to function normally even after drinking what others might consider excess amounts of alcohol. His wife confirms this; they both admit that what began as one or two beers after work a few years ago has … to where he now drinks at least a 12 pack of beer nightly. Regardless, they both confirm that he never “seems drunk,” and this does not interfere with his job or fulfilling his family functions. Jeffrey’s ability to function normally despite high blood alcohol is likely a result of: 50. Question: Sarah is a 23-year-old patient who presents for a follow-up of her major depressive episode. She was … up to maximal dose fluoxetine 6 weeks ago after demonstrating tolerance without side effects at lower doses. Today in follow-up, she reports that she still has no sides effects but no therapeutic effect either. There does not appear to be any measurable improvement of her initial presenting symptoms. The PMHNP knows that the most appropriate approach at this point is to: 51. Question: M.T. is a 39-year-old female being seen by the PMHNP for a major depressive episode. She is being … with SNRI therapy in combination with cognitive behavioral therapy. She is having difficulty achieving remission, and her husband comes with her to this office visit because he is becoming very … He wants to be supportive, but he is finding it very difficult to understand why she is so … M.T. had an episode of depression approximately 2 years ago, but that was when her sister … in an accident. After 6 months of treatment, she … to return to normal. This time, her husband points out that she “has nothing to be … about,” but she has become so … that she has essentially withdrawn from the family. In trying to help M.T.’s husband understand the disease process, the PMHNP discusses with him that: 52. Question: Marcus is an 18-year-old male … for care by his parents. It is time for Marcus to begin exploring colleges and he flat out refuses to do so. Both Marcus and his parents admit that he has had a rather solitary lifestyle. He has been home-… since the eighth grade. According to his parents, he is extremely intelligent and in junior high it became very difficult for him to be in school. He was very uncomfortable in the school setting and it was counterproductive to learning, so the parents were amenable to home schooling. However, now they want him to go to college, but he will not discuss it. When considering differential diagnosis, the PMHNP considers all of the following except: 53. Question: Mrs. Maxwell is a 75-year-old patient with moderate Alzheimer’s dementia. She lives with her son and his wife and generally does very well with her day to day activities. The family understands the importance of routine and Mrs. Maxwell maintains a regular schedule of activities including her meals, … toileting, and recreational activities. Which of the following behaviors should prompt and immediate depression screening for Mrs. Maxwell? 54. Question: Anthony is a 41-year-old male patient who presents for evaluation. His wife made the appointment because she is … about him and he would not seek care on his own. Anthony has become progressively withdrawn over the last few months and is in danger of losing his job because he misses so many days. He has been … by his primary care provider and has no apparent medical conditions. His wife reports that he has been… with depression in the past, and has even taken medication that … to help. This time he just … to pursue care. After a comprehensive assessment, the PMHNP diagnoses the patient with major depressive episode with psychotic features. Consistent with the Texas Algorithm Medication Project (TAMP), the appropriate choice of initial medication therapy would … : [Show Less]
NRNP 6670 Week 6 Mid-term Exam (100% Correct Summer QTR)/ NRNP/PRAC 6670 Psychiatric Mental Health Nurse Practitioner Role II: Adult And Older Adult (75/75... [Show More] ) Walden University Question: From a biological perspective, all of the following neurotransmitters are implicit in the anxiety response except: Question: Mr. Kendall is a 47-year old male who is … to care by his younger sister, Megan. Mr. Kendall has spent his entire adult life living in an apartment that was … to his parents’ home. His mother … a few weeks ago, and the property is listed for sale. Mr. Kendall will have to move, and while discussing this with him, Megan became very concerned. He has apparently been … odd all his life, has never … or even dated as far as Megan knows, but she had no idea how odd he was. When his mother died, he … from reality and had episodes of talking to people who weren’t present. Megan says that sometimes she does not even understand what he is talking about. He seems to think he has psychic powers, and that he doesn’t need to move because he knows the house will not … sold. When considering a diagnosis of schizotypal disorder, the PMHNP expects which of the following to … present in the history? Question: Becci is a 31-year-old female who presents to the PMHNP for evaluation after being … by her friend who is a patient of the practice. She describes a relatively acute, recent onset of panic attacks. Becci says that “out of the blue” her heart starts to race, her mouth gets dry, she gets shaky, and feels like she cannot get her breath. She is afraid because her friend has panic disorder and Becci knows that before her friend got treatment, she basically would not leave the house in case an attack … The PMHNP recognizes that the immediate priority in assessment for Becci is: Question: The PMHNP is working on a graduate program in which he is hoping to develop a new personality assessment tool. After an exhaustive review of the literature and many months of work, he … a tool to use in a research study and needs to establish its psychometric properties. He distributes the tool to four different professionals in the field and asks that they assess whether the questions appear to measure what they are … to measure. This is an assessment of: Question: Among the various psychotherapeutic techniques available for treating post-traumatic stress disorder, which mechanism achieves its effect by having patients work through the traumatic event while in a deep state of relaxation? Question: Alexa is a 27-year-old female who has come to group therapy while she is in the city jail. She was … for vagrancy because she was sleeping in her car in a parking lot at a local shopping center. She could not post bail, so she is … to 14 days in jail. During group, she contributes that none of this is her fault. Her mother is totally evil because she would not let Alexa stay in the family home. She has some other family. but they are all jerks because they won’t help her. Alexa’s friend Melanie is the absolute best person in the world, but she can’t help because her boss … her for no reason. Alexa has a history of arrests for buying illegal drugs and prostitution. The last time she was in jail, her sentence was … for 30 days because she got into a fight with another inmate and beat her up so badly she had to be … to the hospital for 6 days. The PMHNP considers which of the following personality disorders? Question: Janel is a 37-year-old woman who is being … as part of a family assessment. Her 10-year-old son is having some behavioral issues in school and has been … for evaluation. While interviewing Janel, the PMHNP appreciates that she appears very emotional. She expresses extreme distress at her son’s behavior and says she will do anything to help him; they are “best friends.” She is very demonstrative during the assessment and seems unhappy when she is not the center of attention during the evaluation process. She repeatedly talks about her own medical problems, such as recurrent headache and abdominal pain, which her doctors cannot diagnose. Her appearance is very flamboyant, and her dress is more appropriate to a nightclub than a family assessment. In addition to managing her son’s needs, Janel would likely benefit from: Question: Danielle is a 31-year-old female who is having a psychiatric evaluation at the insistence of her husband. They have been …for 4 years, and her husband has finally become so …by her jealous behavior that he … to leave her if she didn’t “get help.” Her husband insists that he has never been unfaithful, but Danielle repeatedly accuses him of having an affair. If he is even a few minutes late getting home from work, she demands an explanation and then does not believe anything he says. She does not have any real friends—her sister is her closest social contact, but Danielle has been angry with her for several weeks and won’t answer phone calls. Reportedly she does this often, and according to her husband can “hold a grudge forever.” During the interview, Danielle is calm, responsive, but distant. She says she really doesn’t understand why she is there—there is not a problem. The PMHNP considers the most likely diagnosis and discusses with Danielle that the treatment of choice is: Question: Patients on lithium carbonate for management of bipolar disorder should … subject to routine assessment of: Question: The PMHNP is …to evaluate the parent of one of her existing patients, a 49-year-old woman … Sheri. Sheri reports that her father, a 78-year-old man who lives alone, has always been in good health. However, when Sheri went to have breakfast with him this past Sunday, she found her father overtly …and he did not even seem to recognize her at first. Sheri is … that he has Alzheimer’s disease, and she is … because two days prior he was “completely fine.” The PMHNP knows that the most likely cause of this presentation is: Question: The PMHNP is … to the acute care unit to evaluate a patient who is …after being brought in by his friends. They were at a party where there were numerous drugs of abuse as well as alcohol. The patient cannot provide a history, and his friends are unclear as to which drugs he … Physical examination reveals a patient who is diaphoretic, tremulous, has a pulse of 130 bpm, dilated pupils, and cannot perform fine motor tasks. These physical findings are most consistent with which type of intoxication? Question: The psychological sciences have …theoretical foundations to the etiology and management of anxiety disorders from both conceptual and practical perspectives. The concept that anxiety develops in persons who feel as though they are living in a world devoid of meaning is an example of which theoretical foundation? Question: Among the various types of therapeutic intervention for patients with borderline personality disorder, which of the following is …as polymodal, including group skills training, individual therapy, telephone consultation, and a consultation team with a goal of improving interpersonal skills and decreasing self-destructive behavior? Question: A variety of pharmacologic agents have …effectiveness in the treatment of post-traumatic stress disorder. Which of the following does not have any evidenced-based support in the literature? Question: Laura T. is a 27-year-old female who has been …for psychiatric evaluation. She has no significant psychiatric or medical history and denies any history of substance abuse, but she is here because she is persistently having olfactory hallucinations. For the last 3 months, she has been having this progressive sense of smelling particularly foul odors—feces, rotting food, trash— with no obvious cause. She made the appointment because she had an uncle who had schizophrenia and he … to have hallucinations too, although he was mostly hearing voices. The PMHNP knows that a priority of assessment includes a: Question: The PMHNP is on call at the local county correctional facility. He is …to evaluate M.S., a 21-year-old male who was just …following an altercation at a local bar. M.S. has never been … before and apparently has no psychiatric or medical history available. His toxicology screen was negative for alcohol or any drugs of abuse. His mother says that he has in the past had some occasions when he got kind of … , but this is the first time it’s been a problem. Reportedly some people from his office were at the bar celebrating a birthday, and before anyone knew what happened an argument …into M.S. getting very loud, yelling, and acting “crazy” before he punched a coworker and started breaking bottles. When considering a manic or hypomanic episode, the PMHNP expects that his speech would most likely … : Question: The PMHNP is conducting an initial interview with a patient whose history is consistent with avoidant personality disorder. The PMHNP understands that one of the most striking features of this interview is likely to … upon the patient’s: Question: Cory is a 23-year-old male recently …in the county correction facility for a 9-month sentence following his third conviction for battery. As part of an early release program, he is …to participate in the therapy program. During his initial interview, he is very pleasant and … , expressing no anxiety or distress with his current circumstances. His psychiatric history is significant for numerous adolescent episodes of running away, truancy, and substance abuse. As a young adult, he reportedly has not held a steady job but rather is constantly coming up with money-making schemes. According to family reports is a personality disorder are very likely to: Question: Which of the following is a true statement with respect to the treatment of narcissistic personality disorder? Question: Darius is a 26-year-old male who presents for care as part of couple therapy with his wife, who is being seen for dependency issues. Darius himself seems very anxious to “do the right thing” and appears to want to please the therapist. During the evaluation, Darius is impeccably … , very formal in his presentation and interaction, and is watchful of time because he has an appointment after the interview and states several times that he cannot … late. The PMHNP considers that Darius may have obsessive compulsive personality disorder (OCPD). In differentiating this from obsessive compulsive disorder (OCD), she explores his history further for: Question: Sarah is a 23-year-old patient who presents for a follow-up of her major depressive episode. She was … up to maximal dose fluoxetine 6 weeks ago after demonstrating tolerance without side effects at lower doses. Today in follow-up, she reports that she still has no sides effects but no therapeutic effect either. There does not appear to … any measurable improvement of her initial presenting symptoms. The PMHNP knows that the most appropriate approach at this point is to: Question: Anthony is a 41-year-old male patient who presents for evaluation. His wife made the appointment because she is …about him and he would not seek care on his own. Anthony has become progressively withdrawn over the last few months and is in danger of losing his job because he misses so many days. He has been … by his primary care provider and has no apparent medical conditions. His wife reports that he has been …with depression in the past, and has even taken medication that …to help. This time he just …to pursue care. After a comprehensive assessment, the PMHNP diagnoses the patient with major depressive episode with psychotic features. Consistent with the Texas Algorithm Medication Project (TAMP), the appropriate choice of initial medication therapy would … : Question: In documenting a mental status exam (MSE) for Janet, a 54-year-old female, the PMHNP notes that she is bradykinesic, has poverty of speech, is … , and appears flat. This includes all the following elements of physical examination except: Question: Which of the following personality disorders is …with females with fragile X syndrome? Question: When developing a pharmacologic treatment plan for the management of major depressive disorder, the PMHNP counsels the patient that the medication will … up to the appropriate dose and then … for a minimum of 3 months; medication must not … abruptly or without provider supervision. This is because the physiologic consequence of abrupt cessation is likely to result in: Question: The PMHNP is considering pharmacotherapeutic options for Ana, a 28-year-old female with …anxiety disorder. Ana is very …about becoming “addicted” to medication, but she is open to pharmacotherapy because there are a lot of things going on in her life and she worries all the time. Her husband is …overseas, she has just … a new job, and her only child has just started kindergarten. Ana denies any panic-type symptoms; her primary concern is that she is … about everything and it is making it hard to sleep and concentrate on learning the skills for her new job. Ana may best benefit from Question: John is a 41-year-old male who presents for management of heroin addiction. He has a long history of opiate abuse spanning decades and has had several unsuccessful attempts at recovery. Because of his lifestyle, he has … a variety of chronic health problems, including cardiomyopathy and stage 2 chronic kidney disease. He currently takes several psychiatric medications for mood disorder. When considering methadone maintenance as a mechanism of treating his opiate addiction, the PMHNP knows that if he requires more than 100 mg of methadone at the start of therapy he should have a baseline: Question: The professional relationship between therapist and patient with schizoid personality disorder is a challenge because these patients do not typically seek care independently. However, once a trusting relationship develops, this type of patient may: Question: Jeffrey T. is a 27-year-old man who has … for care after being … to do so by the county court. He was involved in a car accident, and while he was not at fault for the accident, routine blood alcohol screening … that he was driving while … He is a bit resentful at being required to attend therapy; he is very vocal that his driving was not … and that he is able to function normally even after drinking what others might consider excess amounts of alcohol. His wife confirms this; they both admit that what began as one or two beers after work a few years ago has evolved to where he now drinks at least a 12 pack of beer nightly. Regardless, they both confirm that he never “seems drunk,” and this does not interfere with his job or fulfilling his family functions. Jeffrey’s ability to function normally despite high blood alcohol is likely a result of: Question: Which among the following neurotransmitters is … in depression and … in mania? Question: Maurice is a 22-year-old male who is being … for major depressive episode. He presents today for a follow up visit. He was … on sertraline 50 mg daily 4 weeks ago, and 2 weeks ago, his dose was increased to 150 mg daily. Today he is concerned because he doesn’t really feel much symptom improvement, and he thinks he needs something else. The best response to Maurice is to tell him that: Question: The PMHNP is evaluating Jared, a 47-year-old male who is brought to care by his wife because “he’s not the man I … 20 years ago.” According to his wife, she and Jared have been …for 20 years, have two children, and have lived a “normal” life. Jared owns a local construction company and their marriage has been a solid one, … by the typical day-to-day issues that occur in most marriages, but otherwise happy. For the last 2–3 months, she says Jared has completely … He will get angry for no apparent reason and even broke a lamp once. He tells stupid and offensive jokes that no one else thinks are funny, and even had someone call the police when he continued to make inappropriate remarks to a woman in a restaurant. Jared seems unsure what to say, but his wife is adamant that this is a totally different man from the one she has known. The PMHNP knows that Jared should be evaluated for: Question: The PMHNP is considering a diagnosis of paranoid personality disorder in a new patient. When reviewing the history and physical examination, which of the following findings would … most consistent with this diagnosis? Question: Karen is a 19-year-old female who has been …to care after being seen in the emergency department following a violent sexual assault. She was working late one evening at the shopping mall and … alone to her car after dark. She was … , beaten, and thankfully a passerby saw her lying in some bushes and called 911. Initially she was resistant to mental health care, but now, 2 months later, she feels as though she needs help because she is experiencing a collection of symptoms including flashbacks, dreams of the assault, palpitations, anxiety, and a sense that she is watching the assault happen to her This sense of watching the assault as if she was an observer is characteristic of which diagnostic domain of PTSD? Question: Chantel is a 19-year-old female who presents for care because she thinks she is bipolar. During her initial interview, she admits that she has a long history of feeling like she was the person in the family of whom there were always high expectations, and she was never able to express concerns or feelings of inadequacy. When …why she thinks she is bipolar, she says she gets very moody. She was at the grocery store last week and … and fell. While waiting for help, she could not control her anger and … up to swipe all the food off of the shelves. She has been … from jobs because of her uncontrollable temper; she sometimes “just can’t … around certain people.” Chantel also reports that at times she will go two full days and nights being unable to sleep, and that her mind keeps racing and she can’t “shut it down.” When this happens, she just gets up and does things around the house. Finally, Chantel reports that she cannot hold onto money at all. Whenever she gets a paycheck, she immediately spends it on things that she acknowledges she doesn’t even need. When considering a diagnosis of bipolar disorder, the PMHNP specifically assesses for: Question: A PMHNP student is reviewing his notes from his clinical experience over the past week to prepare his first … case presentation on a patient suffering a major depressive episode. Which of the following patients best represents the DSM-5 criteria for major depressive episode? Question: Mrs. Maxwell is a 75-year-old patient with moderate Alzheimer’s dementia. She lives with her son and his wife and generally does very well with her day to day activities. The family understands the importance of routine and Mrs. Maxwell maintains a regular schedule of activities including her meals, … toileting, and recreational activities. Which of the following behaviors should prompt and immediate depression screening for Mrs. Maxwell? Question: Marlene is a 35-year-old female who is in therapy primarily to develop coping mechanisms for living with her husband, who has narcissistic personality disorder. She is … to the marriage and loves her husband, but finds his … sense of self- importance and complete lack of empathy to … especially difficult. She believes he has a good side, but most of her friends have only ever seen extreme arrogance, and she is embarrassed by that. While counseling Marlene, the PMHNP advises her that patients with narcissistic personality disorder have extremely fragile: Question: Which of the following is a true statement with regard to the etiology of substance abuse? Question: Hugo is a 39-year-old male who has … his wife to come to counseling because he is … about her wine drinking. Hugo says that he and his wife have … a bottle of wine with dinner most nights for the last couple of years, but in the last few months he has become … that she drinks too much. They both agree that she never really becomes … , but he does not like the fact that evening wine has become the most important part of her meal. If he wants to go out, she will only go to a place that has a wine she likes. Last month they went on a week-long vacation, and she insisted on packing enough of her wine to last the whole time. If they go to a restaurant that does not have a wine she likes, she will take her own in a disposable coffee cup. It seems like for the last few months, she has been drinking more and more, occasionally finishing the bottle alone when he doesn’t want any. Both partners agree that there is no interference with work or any activities or responsibilities, but it is causing some tension in their marriage. When considering a diagnosis of substance use disorder, the PMHNP considers that: Question: Clare’s history of personal relationships is … by complete intolerance of being alone. Whether it is an intimate-partner relationship or a close friend, Clare appears to always need someone in her life. She had a live-in boyfriend of 3 years, and while they were together, he took care of everything. The PMHNP expects all of the following to … additional features of Clare’s history except: Question: Sally is a 54-year-old female who presents for care at the urging of her employer. She says that she doesn’t think she needs to … there, but the manager of her division at work strongly … that she make an appointment. She is the evening shift manager in the accounting department of a major online sales organization. Her role requires meticulous accountability of a complex system of production statistics, and she has done this exceedingly well for years. She has been a … employee, and her work is above reproach. A few months ago, the company … a new software program that … a complete revamping of Sally’s department. She has not … well, and her resulting anxiety is almost prohibitive of functioning in her role. During her interview, Sally is very somber and serious, and is clearly having difficulty with this change. She is distraught over the potential of not being able to do her job well and meet her immediate supervisor’s expectations. Recognizing the likely diagnosis, the PMHNP knows that Sally is likely to respond best to: Question: Assessment of the manic state in a patient with bipolar disorder is likely to include all the following except: Question: A 22-year-old male patient is …on sertraline 50 mg p.o. daily after presenting with a major depressive episode. After tolerating without difficulty for 2 weeks, his dose is …to 100 mg p.o. daily. Approximately 4 weeks later he reports an unusual set of new symptoms for the last week and a half. He says he feels “amped up” and just very generally … and nervous. He was short-tempered at work and home and was snapping at people for no good reason. He also reports difficulty concentrating at work. Last week he … disproportionate anger at his work and his boss told him that he was bipolar and should … put on medication. The PMHNP discusses with the patient that: Question: Differentiating post-traumatic stress disorder (PTSD) from panic disorder and … anxiety disorder can … challenging. Which of the following provides the strongest support for PTSD vs the other two differential diagnoses? Question: M.T. is a 39-year-old female being seen by the PMHNP for a major depressive episode. She is being … with SNRI therapy in combination with cognitive behavioral therapy. She is having difficulty achieving remission, and her husband comes with her to this office visit because he is becoming very frustrated. He wants to … supportive, but he is finding it very difficult to understand why she is so … M.T. had an episode of depression approximately 2 years ago, but that was when her sister … in an accident. After 6 months of treatment, she seemed to return to normal. This time, her husband points out that she “has nothing to … depressed about,” but she has become so depressed that she has essentially withdrawn from the family. In trying to help M.T.’s husband understand the disease process, the PMHNP discusses with him that: Question: Cory J. is a 23-year-old male being seen by the PMHNP today for an initial evaluation. He says that he does not think anything is wrong, but his family, including his mother, grandmother, and aunt, have all told him that he must … “mentally ill.” He has been unable to hold a job and has … as a cook at more than five chain restaurants in the last 6 months. He has no real friends—he says his “friends” only call him when they need something but never help him. He is currently staying with his grandmother but …will soon … homeless “unless things change.” While he is telling his story, the PMHNP appreciates that Cory repeatedly includes details that make it hard to understand his point. When … why he thinks he will be homeless, he responds by talking about how many hours he has … and how everything was going well but then his car broke down and he couldn’t afford to fix it because his tax return was held by the IRS. The PMHNP recognizes that this represents an abnormal: Question: The difference between a manic and hypomanic episode is best … by all the following except: Question: The major defensive mechanisms … by patients with histrionic personality disorder include: Question: Mrs. Bowen is a 33-year-old female who presents as a new patient requesting medication for depression. She reports a long history of mood disorders on and off going back to adolescence. She is very articulate in describing her history and reports that neither sertraline nor fluoxetine “worked for her.” She was unable to remember the dose or how long she took the medication. With respect to considering Mrs. Bowen’s medication history, the PMHNP knows that: Question: During the interview of Kevin, a 42-year-old male who presents for treatment because of marital problems, the PMHNP responds to his tears by gently moving a box of tissues toward him. This is a facilitating intervention of interview known as: Question: Validated and reliable instruments are an important part of assessment for both clinical practice and research in psychiatrics. Which of the following tools is currently … the standard for assessing clinical outcomes in treatment studies of schizophrenia Question: Fletcher is a 29-year-old male … for court-ordered counseling. He has a long history of … offenses including DUI, domestic violence, battery, and other violent acts that fortunately have not yet … any serious injury or death to the recipients. An interview with his wife reveals that he has lied about almost everything for the last few years; he is able to get hired for jobs because he is very engaging and likeable, and then invariably he gets fired because he misses work and doesn’t do his job properly when he is there. According to the wife, they have known each other since high school, where Fletcher was very happy and well- … He was on the soccer team, liked by teachers, and never demonstrated the tendencies he does now. Apparently in college he got involved with a fraternity that was notorious for alcohol and drug abuse, and he … drinking heavily; it was “all downhill from there.” The PMHNP considers that: Question: Depressive personality disorder exists along the spectrum of dysthymia and major depressive disorder, but it is different from these two in that: Question: While preparing a class on personality disorders for a class of PMHNP students, the instructor is presenting case studies of patients with cluster A personalities. One of these cases is Clark M., a 41-year-old man who is … as a life-long “loner.” In high school and college, he kept to himself, excelling in his studies in the sciences. Currently …as a brilliant computer programmer, he clearly prefers solitary pursuits and the company of his cat over people. He knows he is socially isolated, but he is just more comfortable this way. This description is most consistent with: Question: Melissa is a family nurse practitioner who is … in a PMHNP program and is beginning her first clinical rotation. After being … to the practice processes and procedures, she is preparing for her first solo interview of a patient who is presenting to the practice to establish care. Melissa knows that, unlike her experience as a primary care nurse practitioner, the first office visit with a psychiatric patient should … : Question: The PMHNP is preparing a presentation for a primary care conference on geriatric health care. The topic is geriatric depression, and this presentation is … to increase recognition of community-dwelling elders at risk. An important talking point in this presentation will include all of the following about geriatric depression except: Question: Margo is a 47-year-old female who admits to a history of fairly heavy alcohol use over many years. She admits that she has had periods in the past where she …drinking for a brief time, but she has always gone back to it. At this point she says she has been drinking a fifth of bourbon every 2–3 days for over a year. She has a new boyfriend and really wants to stop drinking, but she is afraid she will “go into the DTs.” She has been reading about it on the Internet, and she knows it can … fatal. Other than her drinking, Margo is amazingly healthy. She had a complete physical exam with blood work through her primary doctor, and he says that her drinking does not appear to have … her physical health at all. While counseling Margo about alcohol withdrawal delirium (delirium tremens), the PMHNP advises Margo that: Question: Trudy L. is a 29-year-old female patient who … care because she feels like she has no energy. She just had her annual wellness exam and her primary care provider told her that she is in excellent health. Because she … about this excessive fatigue, her PCP … a CBC, CMP, UA and thyroid function tests and was told, along with her physical examination, that everything looks normal. Further discussion reveals that Trudy is having some relationship challenges with her boyfriend of 2 years and this seems to … “spilling over” at work, where she is having persistent conflict with her supervisor. Ultimately the PMHNP diagnoses Trudy with major depressive disorder, mild, single episode. The PMHNP and Trudy discuss treatment options, and Trudy would really like to try nonpharmacologic interventions. Which of the following represents the best approach for Trudy? Question: Marcus is an 18-year-old male … for care by his parents. It is time for Marcus to begin exploring colleges and he flat out refuses to do so. Both Marcus and his parents admit that he has had a rather solitary lifestyle. He has been home-… since the eighth grade. According to his parents, he is extremely intelligent and in junior high it became very difficult for him to … in school. He was very uncomfortable in the school setting and it was counterproductive to learning, so the parents were amenable to home schooling. However, now they want him to go to college, but he will not discuss it. When considering differential diagnosis, the PMHNP considers all of the following except: Question: Jen is a 31-year-old female who presents for care complaining of … mood. During the interview, it becomes apparent that she has a long history of depressive symptoms, as well as a long history of being socially … and feeling generally inadequate. When considering a diagnosis of dysthymia, the PMHNP considers that the core concept of dysthymia refers to sub-affective or subclinical depressive disorder with all of the following except: Question: Kevin is a 24-year-old male who seeks treatment for anxiety. He thinks he has an anxiety disorder because he has a lot of the same symptoms that his mother does, and she takes medications for anxiety. He reports being “constantly wired,” irritable, and not sleeping well. Kevin says he always has energy, but it’s not a good kind of energy. He does not have … panic attacks; he is always just “amped up.” He denies any substance abuse, and he does not smoke cigarettes. When considering organic causes of his symptoms, the PMHNP must evaluate his: Question: When differentiating a major depressive episode from dysthymic disorder, the PMHNP considers that: Question: Mr. Henderson is a 69-year-old man who presents for evaluation and care for depression. His wife … 6 months ago following a difficult 2 years with breast cancer. His primary complaint is that he just does not look forward to anything anymore. He cannot get … in his children and grandchildren, he no longer enjoys any of his hobbies because he and his wife … to do them together. He does not sleep well, and wakes up frequently during the night. He also admits to thinking more and more about dying himself, although he expressly denies suicidal ideation. His medical history is significant for coronary artery disease, osteoarthritis, hypothyroidism, hypertension, and dyslipidemia. He also has atrial fibrillation and is on warfarin for emboli prophylaxis, but he does not remember the names of all of his other medications. When considering pharmacotherapy for Mr. Henderson, the PMHNP considers that which of the following SSRIs is safest with respect for potential drug interactions? Question: The International Study of Expert Judgment on Therapeutic Use of Benzodiazepines and Other Psychotherapeutic Medications was … to gather systematic data on the opinions of leading clinicians concerning the benefits and risks of benzodiazepines and alternative anxiety treatments. Which of the following best characterizes the majority opinion of this group? Question: The PMHNP is seeing a patient who has been … by primary care. The patient was … with major depressive disorder and … on both an SSRI and SNRI by the primary care provider. The patient appears refractory to therapy and has not had any appreciable clinical response. A more … psychiatric history is significant for indicators of bipolar disease, as well as a family history of bipolar disease in both the patient’s father and paternal aunt. This patient will most likely benefit from: Question: When performing a psychiatric assessment of an elderly patient with Alzheimer’s dementia, the PMHNP recognizes that: Question: When evaluating the laboratory assessment of a patient with alcohol use disorder, the PMHNP may reasonably expect to find all of the following abnormalities due to chronic alcohol use except: Question: Joe W. is a 28-year-old male who is currently having an acute manic episode. He has not slept for 3 days, is extremely irritable, and is prone to violent outbursts of anger. He reports what is clearly a … episode of racing thoughts and has … psychotic episodes. According to his history, Joe has been on mood stabilizing medication in the past, but he is very unreliable when it comes to follow-up. When considering medication therapy for Joe, the PMHNP knows that: Question: Anne is a 32-year-old female who …to care after a random drug screening at work was positive for cocaine. She was initially resistant to therapy, maintaining that her use is not a problem and she could stop at any time. Upon further discussion in session, it appears that she uses cocaine every day at work, sometimes 2–3 times, other days more. She also uses it occasionally at home and most weekends. During her third session, she … that it is a financial burden, and she basically cannot afford any other form of recreation. She understands that if she uses again she will lose her job, and she admits that she loves her job and that cocaine is not worth losing it. When counseling her about cessation strategies, the PMHNP advises all the following except: Question: Tim is a 20-year-old male who has been …for care by his college counselor. The counselor has … that Tim engages in virtually no social activities in college, and for that matter avoids day-to-day activities that require social interaction. By his own admission, Tim never participates in class discussions, even in online discussion boards. Tim is so afraid of rejection that he confines himself to his room and his studies. When differentiating schizoid personality from avoidant personality, the PMHNP knows that a primary difference is that: Question: Cannabis intoxication delirium is … by all of the following except: Question: Marie is a 30-year-old woman who presents for follow-up after starting treatment for bipolar disorder. She had been … on and off for depression for years and had a history of alcohol abuse. After her marriage, she … to stop drinking and was successful in eliminating alcohol from her life; unfortunately, she then went on to have a manic episode and was finally … on a mood stabilizer 1 month ago. She … medication very well, and within 2 weeks symptoms were much …. Now, 4 weeks later, she feels much better and wants to come off medication. The PMHNP tells her that: Question: Dependence is a common feature of many psychiatric disorders. One of the primary distinguishing features that differentiates dependent personality disorder from histrionic and borderline personalities is that: Question: Mariel is a middle-aged woman who is … by her primary care provider for management of agoraphobia. Mariel has had this fear as long as she can remember, but now that her children have … away from home she will need to … more independent and is very … to trying to manage her fear. The PMHNP counsels Mariel that the most successful therapy for phobic disorders is: [Show Less]
NRNP 6670 Week 6 Midterm Exam/NRNP/PRAC 6670 Psychiatric Mental Health Nurse Practitioner Role II: Adult And Older Adult Updated (100% All 75Questions Answ... [Show More] ered with Correct Answers) Question: Alexa is a 27-year-old female who has come to group therapy while she is in the city jail. She was … for vagrancy because she was sleeping in her car in a parking lot at a local shopping center. She could not post bail, so she is … to 14 days in jail. During group, she contributes that none of this is her fault. Her mother is totally evil because she would not let Alexa stay in the family home. She has some other family. but they are all jerks because they won’t help her. Alexa’s friend Melanie is the absolute best person in the world, but she can’t help because her boss … her for no reason. Alexa has a history of arrests for buying illegal drugs and prostitution. The last time she was in jail, her sentence was … for 30 days because she got into a fight with another inmate and beat her up so badly she had to … to the hospital for 6 days. The PMHNP considers which of the following personality disorders? Question: Anne is a 32-year-old female who … to care after a random drug screening at work was positive for cocaine. She was initially resistant to therapy, maintaining that her use is not a problem and she could stop at any time. Upon further discussion in session, it appears that she uses cocaine every day at work, sometimes 2–3 times, other days more. She also uses it occasionally at home and most weekends. During her third session, she … that it is a financial burden, and she basically cannot afford any other form of recreation. She understands that if she uses again she will lose her job, and she admits that she loves her job and that cocaine is not worth losing it. When counseling her about cessation strategies, the PMHNP advises all the following except: Question: Clare’s history of personal relationships is … by complete intolerance of being alone. Whether it is an intimate-partner relationship or a close friend, Clare appears to always need someone in her life. She had a live-in boyfriend of 3 years, and while they were together, he took care of everything. The PMHNP expects all of the following to be additional features of Clare’s history except: Question: The PMHNP is conducting an initial interview with a patient whose history is consistent with avoidant personality disorder. The PMHNP understands that one of the most striking features of this interview is likely to … upon the patient’s: Question: A PMHNP student is reviewing his notes from his clinical experience over the past week to prepare his first … case presentation on a patient suffering a major depressive episode. Which of the following patients best represents the DSM-5 criteria for major depressive episode? Question: A variety of pharmacologic agents have … effectiveness in the treatment of post-traumatic stress disorder. Which of the following does not have any evidenced-based support in the literature? Question: The PMHNP is on call at the local county correctional facility. He is … to evaluate M.S., a 21-year-old male who was just … following an altercation at a local bar. M.S. has never been incarcerated before and apparently has no psychiatric or medical history available. His toxicology screen was negative for alcohol or any drugs of abuse. His mother says that he has in the past had some occasions when he got kind of …, but this is the first time it’s been a problem. Reportedly some people from his office were at the bar celebrating a birthday, and before anyone knew what … an argument escalated into M.S. getting very loud, yelling, and acting ―crazy‖ before he … a coworker and … breaking bottles. When considering a manic or hypomanic episode, the PMHNP expects that his speech would most likely be: Question: Fletcher is a 29-year-old male … for court-ordered counseling. He has a long history of … offenses including DUI, domestic violence, battery, and other violent acts that fortunately have not yet caused any serious injury or death to the recipients. An interview with his wife reveals that he has … about almost everything for the last few years; he is able to get … for jobs because he is very engaging and likeable, and then invariably he gets fired because he misses work and doesn’t do his job properly when he is there. According to the wife, they have known each other since high school, where Fletcher was very happy and well-adjusted. He was on the soccer team, liked by teachers, and never demonstrated the tendencies he does now. Apparently in college he got … with a fraternity that was notorious for alcohol and drug abuse, and he … drinking heavily; it was ―all downhill from there. The PMHNP considers that: Question: Which among the following neurotransmitters is … in depression and increased in mania? Question: Among the various types of therapeutic intervention for patients with borderline personality disorder, which of the following is … as polymodal, including group skills training, individual therapy, telephone consultation, and a consultation team with a goal of improving interpersonal skills and decreasing self-destructive behavior? Question: Kendall is a 47-year old male who is … to care by his younger sister, Megan. Mr. Kendall has spent his entire adult life living in an apartment that was … to his parents’ home. His mother died a few weeks ago, and the property is listed for sale. Mr. Kendall will have to move, and while discussing this with him, Megan became very concerned. He has apparently been … odd all his life, has never … or even dated as far as Megan knows, but she had no idea how odd he was. When his mother died, he seemed … from reality and had episodes of talking to people who weren’t present. Megan says that sometimes she does not even understand what he is talking about. He seems to think he has psychic powers, and that he doesn’t need to move because he knows the house will not be sold. When considering a diagnosis of schizotypal disorder, the PMHNP expects which of the following to be present in the history? Question: Which of the following is a true statement with respect to the treatment of narcissistic personality disorder? Question: While preparing a class on personality disorders for a class of PMHNP students, the instructor is presenting case studies of patients with cluster A personalities. One of these cases is Clark M., a 41-year-old man who is … as a life-long ―‖ In high school and college, he kept to himself, excelling in his studies in the sciences. Currently … as a brilliant computer programmer, he clearly prefers solitary pursuits and the company of his cat over people. He knows he is socially …, but he is just more comfortable this way. This description is most consistent with: Question: Darius is a 26-year-old male who presents for care as part of couple therapy with his wife, who is being seen for dependency Darius himself seems very anxious to ―do the right thing‖ and appears to want to please the therapist. During the evaluation, Darius is impeccably … , very formal in his presentation and interaction, and is watchful of time because he has an appointment after the interview and states several times that he cannot be late. The PMHNP considers that Darius may have obsessive compulsive personality disorder (OCPD). In differentiating this from obsessive compulsive disorder (OCD), she explores his history further for: Question: Hugo is a 39-year-old male who has … his wife to come to counseling because he is … about her wine drinking. Hugo says that he and his wife have shared a bottle of wine with dinner most nights for the last couple of years, but in the last few months he has become … that she drinks too much. They both agree that she never really becomes intoxicated, but he does not like the fact that evening wine has become the most important part of her meal. If he wants to go out, she will only go to a place that has a wine she likes. Last month they went on a week-long vacation, and she … on packing enough of her wine to last the whole time. If they go to a restaurant that does not have a wine she likes, she will take her own in a disposable coffee cup. It seems like for the last few months, she has been drinking more and more, occasionally finishing the bottle alone when he doesn’t want any. Both partners agree that there is no interference with work or any activities or responsibilities, but it is causing some tension in their marriage. When considering a diagnosis of substance use disorder, the PMHNP considers that: Question: When developing a pharmacologic treatment plan for the management of major depressive disorder, the PMHNP counsels the patient that the medication will … up to the appropriate dose and then continued for a minimum of 3 months; medication must not … abruptly or without provider supervision. This is because the physiologic consequence of abrupt cessation is likely to result in: Question: Which of the following is a true statement with regard to the etiology of substance abuse? Question: Assessment of the manic state in a patient with bipolar disorder is likely to include all the following except: Question: When performing a psychiatric assessment of an elderly patient with Alzheimer’s dementia, the PMHNP recognizes that: Question: Jeffrey T. is a 27-year-old man who has … for care after being … to do so by the county court. He was involved in a car accident, and while he was not at fault for the accident, routine blood alcohol screening revealed that he was driving while … He is a bit resentful at being … to attend therapy; he is very vocal that his driving was not … and that he is able to function normally even after drinking what others might consider excess amounts of alcohol. His wife confirms this; they both admit that what began as one or two beers after work a few years ago has evolved to where he now drinks at least a 12 pack of beer nightly. Regardless, they both confirm that he never ―seems drunk,‖ and this does not interfere with his job or fulfilling his family functions. Jeffrey’s ability to function normally despite high blood alcohol is likely a result of: Question: Danielle is a 31-year-old female who is having a psychiatric evaluation at the insistence of her husband. They have been … for 4 years, and her husband has finally become so … by her jealous behavior that he … to leave her if she didn’t ―get help.‖ Her husband insists that he has never been unfaithful, but Danielle … accuses him of having an affair. If he is even a few minutes late getting home from work, she demands an explanation and then does not believe anything he says. She does not have any real friends—her sister is her closest social contact, but Danielle has been angry with her for several weeks and won’t answer phone calls. Reportedly she does this often, and according to her husband can ―hold a grudge forever.‖ During the interview, Danielle is calm, responsive, but distant. She says she really doesn’t understand why she is there—there is not a problem. The PMHNP considers the most likely diagnosis and discusses with Danielle that the treatment of choice is: Question: Margo is a 47-year-old female who admits to a history of fairly heavy alcohol use over many years. She admits that she has had periods in the past where she … drinking for a brief time, but she has always gone back to At this point she says she has been drinking a fifth of bourbon every 2–3 days for over a year. She has a new boyfriend and really wants to stop drinking, but she is afraid she will ―go into the DTs.‖ She has been reading about it on the Internet, and she knows it can be fatal. Other than her drinking, Margo is amazingly healthy. She had a complete physical exam with blood work through her primary doctor, and he says that her drinking does not appear to have … her physical health at all. While counseling Margo about alcohol withdrawal delirium (delirium tremens), the PMHNP advises Margo that: Question: Anthony is a 41-year-old male patient who presents for evaluation. His wife made the appointment because she is … about him and he would not seek care on his own. Anthony has become progressively withdrawn over the last few months and is in danger of losing his job because he misses so many days. He has been … by his primary care provider and has no apparent medical conditions. His wife reports that he has been … with depression in the past, and has even taken medication that seemed to help. This time he just … to pursue care. After a comprehensive assessment, the PMHNP diagnoses the patient with major depressive episode with psychotic features. Consistent with the Texas Algorithm Medication Project (TAMP), the appropriate choice of initial medication therapy would be: Question: Marlene is a 35-year-old female who is in therapy primarily to develop coping mechanisms for living with her husband, who has narcissistic personality disorder. She is … to the marriage and loves her husband, but finds his … sense of self-importance and complete lack of empathy to be especially difficult. She believes he has a good side, but most of her friends have only ever seen extreme arrogance, and she is … by that. While counseling Marlene, the PMHNP advises her that patients with narcissistic personality disorder have extremely fragile: Question: Marie is a 30-year-old woman who presents for follow-up after starting treatment for bipolar disorder. She had been … on and off for depression for years and had a history of alcohol After her marriage, she … to stop drinking and was successful in eliminating alcohol from her life; unfortunately, she then went on to have a manic episode and was finally … on a mood stabilizer 1 month ago. She … medication very well, and within 2 weeks symptoms were much improved. Now, 4 weeks later, she feels much better and wants to come off medication. The PMHNP tells her that: Question: Validated and reliable instruments are an important part of assessment for both clinical practice and research in psychiatrics. Which of the following tools is currently … the standard for assessing clinical outcomes in treatment studies of schizophrenia? Question: Among the various psychotherapeutic techniques available for treating post-traumatic stress disorder, which mechanism achieves its effect by having patients work through the traumatic event while in a deep state of relaxation? Question: A 22-year-old male patient is … on sertraline 50 mg p.o. daily after presenting with a major depressive episode. After tolerating without difficulty for 2 weeks, his dose is … to 100 mg p.o. daily. Approximately 4 weeks later he reports an unusual set of new symptoms for the last week and a half. He says he feels ―amped up‖ and just very generally agitated and nervous. He was short-… at work and home and was snapping at people for no good reason. He also reports difficulty concentrating at work. Last week he … disproportionate anger at his work and his boss told him that he was bipolar and should be put on medication. The PMHNP discusses with the patient that: Question: The PMHNP is seeing a patient who has been … by primary care. The patient was … with major depressive disorder and … on both an SSRI and SNRI by the primary care provider. The patient appears refractory to therapy and has not had any appreciable clinical response. A more … psychiatric history is significant for indicators of bipolar disease, as well as a family history of bipolar disease in both the patient’s father and paternal aunt. This patient will most likely benefit from: Question: Mariel is a middle-aged woman who is … by her primary care provider for management of agoraphobia. Mariel has had this fear as long as she can remember, but now that her children have … away from home she will need to be more independent and is very … to trying to manage her fear. The PMHNP counsels Mariel that the most successful therapy for phobic disorders is: Question: Cannabis intoxication delirium is … by all of the following except: Question: Tim is a 20-year-old male who has been … for care by his college counselor. The counselor has … that Tim engages in virtually no social activities in college, and for that matter avoids day-to-day activities that require social interaction. By his own admission, Tim never participates in class discussions, even in online discussion Tim is so afraid of rejection that he confines himself to his room and his studies. When differentiating schizoid personality from avoidant personality, the PMHNP knows that a primary difference is that: Question: Cory J. is a 23-year-old male being seen by the PMHNP today for an initial evaluation. He says that he does not think anything is wrong, but his family, including his mother, grandmother, and aunt, have all told him that he must be ―mentally ‖ He has been unable to hold a job and has … as a cook at more than five chain restaurants in the last 6 months. He has no real friends—he says his ―friends‖ only call him when they need something but never help him. He is currently staying with his grandmother but reportedly will soon … homeless ―unless things change.‖ While he is telling his story, the PMHNP appreciates that Cory repeatedly includes details that make it hard to understand his point. When … why he thinks he will be homeless, he responds by talking about how many hours he has … and how everything was going well but then his car broke down and he couldn’t afford to fix it because his tax return was held by the IRS. The PMHNP recognizes that this represents an abnormal: Question: Cory is a 23-year-old male recently … in the county correction facility for a 9-month sentence following his third conviction for battery. As part of an early release program, he is … to participate in the therapy program. During his initial interview, he is very pleasant and engaged, expressing no anxiety or distress with his current circumstances. His psychiatric history is significant for numerous adolescent episodes of running away, truancy, and substance abuse. As a young adult, he reportedly has not held a steady job but rather is constantly coming up with money-making schemes. According to family reports is a personality disorder are very likely to: Question: Maxwell is a 75-year-old patient with moderate Alzheimer’s dementia. She lives with her son and his wife and generally does very well with her day to day activities. The family understands the importance of routine and Mrs. Maxwell maintains a regular schedule of activities including her meals, … toileting, and recreational activities. Which of the following behaviors should prompt and immediate depression screening for Mrs. Maxwell? Question: The psychological sciences have … theoretical foundations to the etiology and management of anxiety disorders from both conceptual and practical perspectives. The concept that anxiety develops in persons who feel as though they are living in a world devoid of meaning is an example of which theoretical foundation? Question: Bowen is a 33-year-old female who presents as a new patient requesting medication for depression. She reports a long history of mood disorders on and off going back to adolescence. She is very articulate in describing her history and reports that neither sertraline nor fluoxetine ―worked for her.‖ She was unable to remember the dose or how long she took the medication. With respect to considering Mrs. Bowen’s medication history, the PMHNP knows that: Question: Dependence is a common feature of many psychiatric disorders. One of the primary distinguishing features that differentiates dependent personality disorder from histrionic and borderline personalities is that: Question: T. is a 39-year-old female being seen by the PMHNP for a major depressive episode. She is being … with SNRI therapy in combination with cognitive behavioral therapy. She is having difficulty achieving remission, and her husband comes with her to this office visit because he is becoming very … He wants to be supportive, but he is finding it very difficult to understand why she is so … M.T. had an episode of depression approximately 2 years ago, but that was when her sister … in an accident. After 6 months of treatment, she … to return to normal. This time, her husband points out that she ―has nothing to … about,‖ but she has become so … that she has essentially withdrawn from the family. In trying to help M.T.’s husband understand the disease process, the PMHNP discusses with him that: Question: Becci is a 31-year-old female who presents to the PMHNP for evaluation after being … by her friend who is a patient of the She describes a relatively acute, recent onset of panic attacks. Becci says that ―out of the blue‖ her heart starts to race, her mouth gets dry, she gets shaky, and feels like she cannot get her breath. She is afraid because her friend has panic disorder and Becci knows that before her friend got treatment, she basically would not leave the house in case an attack happened. The PMHNP recognizes that the immediate priority in assessment for Becci is: Question: The difference between a manic and hypomanic episode is best … by all the following except: Question: Janel is a 37-year-old woman who is being … as part of a family assessment. Her 10-year-old son is having some behavioral issues in school and has been … for evaluation. While interviewing Janel, the PMHNP appreciates that she appears very emotional. She expresses extreme distress at her son’s behavior and says she will do anything to help him; they are ―best friends.‖ She is very demonstrative during the assessment and seems unhappy when she is not the center of attention during the evaluation process. She repeatedly talks about her own medical problems, such as recurrent headache and abdominal pain, which her doctors cannot diagnose. Her appearance is very flamboyant, and her dress is more appropriate to a nightclub than a family assessment. In addition to managing her son’s needs, Janel would likely benefit from: Question: The PMHNP is … to evaluate the parent of one of her existing patients, a 49-year-old woman … Sheri. Sheri reports that her father, a 78-year-old man who lives alone, has always been in good health. However, when Sheri went to have breakfast with him this past Sunday, she found her father overtly … and he did not even seem to recognize her at first. Sheri is … that he has Alzheimer’s disease, and she is … because two days prior he was ―completely ‖ The PMHNP knows that the most likely cause of this presentation is: Question: In documenting a mental status exam (MSE) for Janet, a 54-year-old female, the PMHNP notes that she is bradykinesic, has poverty of speech, is … , and appears flat. This includes all the following elements of physical examination except: Question: Jen is a 31-year-old female who presents for care complaining of … mood. During the interview, it becomes apparent that she has a long history of depressive symptoms, as well as a long history of being socially … and feeling generally inadequate. When considering a diagnosis of dysthymia, the PMHNP considers that the core concept of dysthymia refers to sub-affective or subclinical depressive disorder with all of the following except: Question: Which of the following personality disorders is … with females with fragile X syndrome? Question: The PMHNP is evaluating Jared, a 47-year-old male who is brought to care by his wife because ―he’s not the man I … 20 years ago.‖ According to his wife, she and Jared have been … for 20 years, have two children, and have lived a ―normal‖ Jared owns a local construction company and their marriage has been a solid one, … by the typical day-to-day issues that occur in most marriages, but otherwise happy. For the last 2–3 months, she says Jared has completely changed. He will get angry for no apparent reason and even broke a lamp once. He tells stupid and offensive jokes that no one else thinks are funny, and even had someone call the police when he … to make inappropriate remarks to a woman in a restaurant. Jared seems unsure what to say, but his wife is adamant that this is a totally different man from the one she has known. The PMHNP knows that Jared should … for: Question: Trudy L. is a 29-year-old female patient who … care because she feels like she has no energy. She just had her annual wellness exam and her primary care provider told her that she is in excellent health. Because she … about this excessive fatigue, her PCP … a CBC, CMP, UA and thyroid function tests and was told, along with her physical examination, that everything looks normal. Further discussion reveals that Trudy is having some relationship challenges with her boyfriend of 2 years and this seems to be ―spilling over‖ at work, where she is having persistent conflict with her supervisor. Ultimately the PMHNP diagnoses Trudy with major depressive disorder, mild, single episode. The PMHNP and Trudy discuss treatment options, and Trudy would really like to try nonpharmacologic interventions. Which of the following represents the best approach for Trudy? Question: Maurice is a 22-year-old male who is being … for major depressive episode. He presents today for a follow up visit. He was … on sertraline 50 mg daily 4 weeks ago, and 2 weeks ago, his dose was … to 150 mg daily. Today he is … because he doesn’t really feel much symptom improvement, and he thinks he needs something else. The best response to Maurice is to tell him that: Question: Depressive personality disorder exists along the spectrum of dysthymia and major depressive disorder, but it is different from these two in that: Question: Karen is a 19-year-old female who has been … to care after being seen in the emergency department following a violent sexual assault. She was working late one evening at the shopping mall and … alone to her car after dark. She was … , beaten, and thankfully a passerby saw her lying in some bushes and … 911. Initially she was resistant to mental health care, but now, 2 months later, she feels as though she needs help because she is experiencing a collection of symptoms including flashbacks, dreams of the assault, palpitations, anxiety, and a sense that she is watching the assault happen to her This sense of watching the assault as if she was an observer is characteristic of which diagnostic domain of PTSD? Question: Melissa is a family nurse practitioner who is … in a PMHNP program and is beginning her first clinical rotation. After being … to the practice processes and procedures, she is preparing for her first solo interview of a patient who is presenting to the practice to establish care. Melissa knows that, unlike her experience as a primary care nurse practitioner, the first office visit with a psychiatric patient should be: Question: The International Study of Expert Judgment on Therapeutic Use of Benzodiazepines and Other Psychotherapeutic Medications was … to gather systematic data on the opinions of leading clinicians concerning the benefits and risks of benzodiazepines and alternative anxiety treatments. Which of the following best characterizes the majority opinion of this group? Question: Differentiating post-traumatic stress disorder (PTSD) from panic disorder and … anxiety disorder can be challenging. Which of the following provides the strongest support for PTSD vs the other two differential diagnoses? Question: John is a 41-year-old male who presents for management of heroin addiction. He has a long history of opiate abuse spanning decades and has had several unsuccessful attempts at recovery. Because of his lifestyle, he has … a variety of chronic health problems, including cardiomyopathy and stage 2 chronic kidney disease. He currently takes several psychiatric medications for mood disorder. When considering methadone maintenance as a mechanism of treating his opiate addiction, the PMHNP knows that if he requires more than 100 mg of methadone at the start of therapy he should have a baseline: Question: During the interview of Kevin, a 42-year-old male who presents for treatment because of marital problems, the PMHNP responds to his tears by gently moving a box of tissues toward him. This is a facilitating intervention of interview known as: Question: When evaluating the laboratory assessment of a patient with alcohol use disorder, the PMHNP may reasonably expect to find all of the following abnormalities due to chronic alcohol use except: Question: Henderson is a 69-year-old man who presents for evaluation and care for depression. His wife … 6 months ago following a difficult 2 years with breast cancer. His primary complaint is that he just does not look forward to anything anymore. He cannot get … in his children and grandchildren, he no longer enjoys any of his hobbies because he and his wife … to do them together. He does not sleep well, and wakes up frequently during the night. He also admits to thinking more and more about dying himself, although he expressly denies suicidal ideation. His medical history is significant for coronary artery disease, osteoarthritis, hypothyroidism, hypertension, and dyslipidemia. He also has atrial fibrillation and is on warfarin for emboli prophylaxis, but he does not remember the names of all of his other medications. When considering pharmacotherapy for Mr. Henderson, the PMHNP considers that which of the following SSRIs is safest with respect for potential drug interactions? Question: The PMHNP is … to the acute care unit to evaluate a patient who is … after being brought in by his friends. They were at a party where there were numerous drugs of abuse as well as alcohol. The patient cannot provide a history, and his friends are unclear as to which drugs he … Physical examination reveals a patient who is diaphoretic, tremulous, has a pulse of 130 bpm, … pupils, and cannot perform fine motor tasks. These physical findings are most consistent with which type of intoxication? Question: Kevin is a 24-year-old male who seeks treatment for anxiety. He thinks he has an anxiety disorder because he has a lot of the same symptoms that his mother does, and she takes medications for anxiety. He reports being ―constantly … ,‖ irritable, and not sleeping Kevin says he always has energy, but it’s not a good kind of energy. He does not have … panic attacks; he is always just ―amped up.‖ He denies any substance abuse, and he does not smoke cigarettes. When considering organic causes of his symptoms, the PMHNP must evaluate his: Question: A biological perspective, all of the following neurotransmitters are implicit in the anxiety response except: Question: Laura T. is a 27-year-old female who has been … for psychiatric evaluation. She has no significant psychiatric or medical history and denies any history of substance abuse, but she is here because she is persistently having olfactory hallucinations. For the last 3 months, she has been having this progressive sense of smelling particularly foul odors—feces, rotting food, trash— with no obvious cause. She made the appointment because she had an uncle who had schizophrenia and he … to have hallucinations too, although he was mostly hearing voices. The PMHNP knows that a priority of assessment includes a: Question: Marcus is an 18-year-old male … for care by his parents. It is time for Marcus to begin exploring colleges and he flat out refuses to do so. Both Marcus and his parents admit that he has had a rather solitary lifestyle. He has been home-… since the eighth grade. According to his parents, he is extremely intelligent and in junior high it became very difficult for him to be in school. He was very uncomfortable in the school setting and it was counterproductive to learning, so the parents were amenable to home schooling. However, now they want him to go to college, but he will not discuss it. When considering differential diagnosis, the PMHNP considers all of the following except: Question: Chantel is a 19-year-old female who presents for care because she thinks she is bipolar. During her initial interview, she admits that she has a long history of feeling like she was the person in the family of whom there were always high expectations, and she was never able to express concerns or feelings of inadequacy. When … why she thinks she is bipolar, she says she gets very moody. She was at the grocery store last week and … and fell. While waiting for help, she could not control her anger and … up to swipe all the food off of the shelves. She has been … from jobs because of her uncontrollable temper; she sometimes ―just can’t be around certain ‖ Chantel also reports that at times she will go two full days and nights being unable to sleep, and that her mind keeps racing and she can’t ―shut it down.‖ When this happens, she just gets up and does things around the house. Finally, Chantel reports that she cannot hold onto money at all. Whenever she gets a paycheck, she immediately spends it on things that she acknowledges she doesn’t even need. When considering a diagnosis of bipolar disorder, the PMHNP specifically assesses for: Question: Joe W. is a 28-year-old male who is currently having an acute manic episode. He has not slept for 3 days, is extremely irritable, and is prone to violent outbursts of anger. He reports what is clearly a … episode of racing thoughts and has … psychotic episodes. According to his history, Joe has been on mood stabilizing medication in the past, but he is very unreliable when it comes to follow-up. When considering medication therapy for Joe, the PMHNP knows that: Question: The professional relationship between therapist and patient with schizoid personality disorder is a challenge because these patients do not typically seek care independently. However, once a trusting relationship develops, this type of patient may: Question: Patients on lithium carbonate for management of bipolar disorder should be subject to routine assessment of: The PMHNP is preparing a presentation for a primary care conference on geriatric health care. The topic is geriatric depression, and this presentation is … to increase recognition of community-dwelling elders at risk. An important talking point in this presentation will include all of the following about geriatric depression except: Question: When differentiating a major depressive episode from dysthymic disorder, the PMHNP considers that: Question: Sarah is a 23-year-old patient who presents for a follow-up of her major depressive episode. She was … up to maximal dose fluoxetine 6 weeks ago after demonstrating tolerance without side effects at lower doses. Today in follow-up, she reports that she still has no sides effects but no therapeutic effect either. There does not appear to be any measurable improvement of her initial presenting symptoms. The PMHNP knows that the most appropriate approach at this point is to: Question: The PMHNP is working on a graduate program in which he is hoping to develop a new personality assessment tool. After an exhaustive review of the literature and many months of work, he … a tool to use in a research study and needs to establish its psychometric properties. He distributes the tool to four different professionals in the field and asks that they assess whether the questions appear to measure what they are … to measure. This is an assessment of: Question: The PMHNP is considering a diagnosis of paranoid personality disorder in a new patient. When reviewing the history and physical examination, which of the following findings would be most consistent with this diagnosis? Question: The major defensive mechanisms … by patients with histrionic personality disorder include: Question: The PMHNP is considering pharmacotherapeutic options for Ana, a 28-year-old female with … anxiety Ana is very … about becoming ―addicted‖ to medication, but she is open to pharmacotherapy because there are a lot of things going on in her life and she worries all the time. Her husband is … overseas, she has just … a new job, and her only child has just … kindergarten. Ana denies any panic-type symptoms; her primary concern is that she is … about everything and it is making it hard to sleep and concentrate on learning the skills for her new job. Ana may best benefit from: Question: Sally is a 54-year-old female who presents for care at the urging of her employer. She says that she doesn’t think she needs to be there, but the manager of her division at work strongly … that she make an appointment. She is the evening shift manager in the accounting department of a major online sales organization. Her role requires meticulous accountability of a complex system of production statistics, and she has done this exceedingly well for years. She has been a … employee, and her work is above reproach. A few months ago, the company … a new software program that … a complete revamping of Sally’s department. She has not … well, and her resulting anxiety is almost prohibitive of functioning in her role. During her interview, Sally is very somber and serious, and is clearly having difficulty with this change. She is distraught over the potential of not being able to do her job well and meet her immediate supervisor’s expectations. Recognizing the … diagnosis, the PMHNP knows that Sally is likely to respond best to: [Show Less]
NURS 6670 FINAL EXAM LATEST UPDATES WITH DEFINATIONS 75/75 (WU) DEFINATIONS: You will find definitions of below word in this document for you to be able ... [Show More] to understand well each and every Question 1. Narcolepsy: 2. Kleene-Levin syndrome 3. Paraphilia 4. Vascular dementia 5. Paradoxical insomnia 6. Catatonia: Types of catatonia I. A kinetic catatonia II. Excited catatonia III. Malignant catatonia 7. Psychodynamic Theories 8. Circadian rhythm sleep disorder 9. Korsakoff syndrome 10. Loss of ego boundaries 11. Androgen insensitivity syndrome 12. Hyper orality and declining hygiene 13. Sleep onset REM period Q U E S T I O N 1 Collette is a 23-year-old female who presented for emergency care with her mother because her behavior has become increasingly erratic and caused her to lose her job. Her mother reports that she had never done anything like this in the past, but about 3 months ago, her boyfriend of 3 years broke up with her, and Collette began to express unrealistic beliefs that her boyfriend wanted to drive her crazy and hurt her. A gentleman trying to hail a taxi accidentally bumped into her this morning, and she started screaming that her ex-boyfriend had hired the man to throw her into the street under a car. Collette is on a 2-week suspension from her job as a restaurant server because she was combative to a customer— she accused him of colluding with her ex-boyfriend to get her fired. After this morning's incident, her mother was so worried she brought her to the emergency room. Her appearance is disheveled; she is clearly hyper alert and is crying that her boyfriend must have converted her mother to work against her. Head imaging, screening lab, and a toxicology screen are negative. A leading differential for Collette is: -Bipolar disorder -Acute psychotic episode -Schizophreniform disorder -Post-traumatic stress disorder Q U E S T I O N 2 Jake and Laurie are a young married couple who have been referred to mental health counseling because Jake is having disturbing sleep events. Laurie reports that on more than one occasion she has awakened to find Jake having what appears to be a panic attack, but he doesn't seem to realize it. When he finally wakes up, he is confused and doesn't really understand what happened, although he does have a sense of intense fear. This has happened twice in the last 2 weeks, and the last time Laurie heard him screaming. Jake is now a bit afraid to go to sleep and as a result does not feel well the next day. The PMHNP recognizes that sleep terrors in adults: -Are often associated with trauma or psychiatric problems -Represent a disorder of REM sleep -May be a symptom of temporal lobe epilepsy -Is treated with a cycle of sleep deprivation Q U E S T I O N 3 Jack is a 27-year-old male who has a history of paranoid schizophrenia that first became apparent approximately 10 years ago. He developed paranoid delusions and eventually decompensated to the point that he required inpatient stabilization. At the time, he was started on conventional antipsychotics, but due to intolerable adverse effects he was switched to haloperidol. It worked well, but whenever he stopped taking it, symptoms would recur. After several hospitalizations, he was stabilized. The neurophysiologic theory of schizophrenia suggests that Jack's symptoms were a result of: -Increased dopamine activity in the mesolimbic pathway -Increased dopamine activity in the mesocortical pathway -Increased glutamate in the prefrontal cortex -Increased glutamate in the hippocampus Q U E S T I O N 4 Johanne is a 22-year-old female who is being treated for narcolepsy. She is attempting to implement a regimen of forced daytime naps in an effort to manage her condition without pharmacotherapy as she is generally averse to taking medications. While following Johanne, the PMHNP should be alert to signs and symptoms of -Suicidality -Depression -Hyperphagia -Disinhibition Q U E S T I O N 5 The PMHNP is asked to prepare a presentation for non-nursing health care workers in a local long-term care facility on the various causes of cognitive impairment in the elderly. A case presentation approach is used to reinforce principles of identifying delirium, which needs to be reported to the patient's attending provider right away. The case should emphasize which of the following features as being closely correlated with delirium? -Perceptual disturbances -Rapid onset -Agitation -Abnormal sleep patterns Q U E S T I O N 6 Valerie is a 27-year-old woman who has been referred by her primary care provider. She was initially diagnosed with major depressive episode following a breakup with her boyfriend of 7 years. They moved into a house together 1 year ago, but within a few months the boyfriend moved out. Valerie was unresponsive to medication for depression and was referred to the mental health clinic. During this initial psychiatric evaluation, the PMHNP learns that a primary reason for the breakup was that Valerie had an extensive routine every night of repeatedly checking every door and window in the home to ensure that they were locked. Valerie's nighttime routine is exhaustive and involves checking every door and window at least four times. She has a remote history of being attacked in her home while alone and states that she is unable to go to bed until she is certain that every door and window is locked. When considering diagnostic criteria for OCD, the PMHNP needs further assessment to ascertain which diagnostic criteria? -The patient has tried unsuccessfully to suppress the urge to repeatedly check locks -The compulsive activities are time-consuming to the extent that at least 1 hour daily is spent on them -The disturbance is not better explained as the symptoms of another mental disorder -The patient has good or fair insight with respect to the appropriateness of her behaviors Q U E S T I O N 7 Michael is an 18-year-old male who is presented to care at the urging of his parents. He has never had any significant medical or psychiatric problems in the past, but during his first semester at college he has developed a very alarming pattern of excess sleep. He is missing classes and is in danger of losing a scholarship. He is sleeping normally at night but apparently is having these very long episodes of napping and sleeping during the day. When he is awake, he tends to be rather withdrawn. His parents have taken him to their family practitioner as they thought he might be using drugs. A full exam, laboratory assessment, and toxicology screen are all normal, and there is no apparent cause for this sleepiness. While very rare, the PMHNP considers Kleine-Levin syndrome and further assesses for coincident onset of: -Narcolepsy -Mood disorder -Hyper sexuality -Alcohol Q U E S T I O N 8 The primary differentiating feature between mild cognitive impairment (MCI) and Alzheimer's dementia is: -The presence of the apolipoprotein E4 gene -Performance on objective neuropsychiatric testing -Presence or absence of functional impairment -Atrophy of the hippocampal volume Q U E S T I O N 9 Physiologic assessment of patients with paraphilia’s has demonstrated that most them have: -Abnormal hormone levels -Hard or soft neurological signs -Chromosomal abnormalities -Electroencephalogram (EEG) abnormalities Q U E S T I O N 10 Donna is a 41-year-old woman who is being evaluated at the request of her primary care provider for obsessive compulsive disorder. Which of the following aspects of Donna's family medical history should prompt an immediate referral to a neurologist? -Father committed suicide at age 38 -Mother died from Huntington’s chorea -Sister has temporal lobe epilepsy -Brother has profound eczema Q U E S T I O N 11 With respect to the treatment of obsessive compulsive disorder, which of the following statements best characterizes the role of psychotherapy? -Best treatment outcomes occur when patients combine psychotherapy with pharmacotherapy -Psychotherapy is superior to behavior therapy as a nonpharmacological adjunct to medications -Psychodynamic exploration of a patient’s resistance to treatment may improve compliance to therapy -There is no apparent benefit to psychotherapy in the management of obsessive compulsive disorder Q U E S T I O N 12 Jamal is a 31-year-old male who is being evaluated by the PMHNP as part of required care following a suicide attempt. He has never had mental health care before, but his history reveals a significant history of substance abuse. Upon further assessment, Jamal reveals that the reason he uses drugs and alcohol is that he becomes most aroused sexually when he dresses in women's clothing. He is distressed by this. He says he is attracted to women, he is not gay, but he is just most aroused in this way. He admits that even when he was little, he was always drawn to his mother's and sister's clothing and underwear. Jamal's condition is best characterized as -Gender dysphoria -Intersex condition -Sexual identity disorder -Paraphilia Q U E S T I O N 13 The primary difference between sleepwalking and rapid eye movement behavior disorder (RBD) is that: -Sleepwalkers do not have REM-mediated paralysis -Sleepwalkers are acting on the dream imagery -RBD patients do not respond to pharmacotherapy -RBD may be due to a variety of brain abnormalities Q U E S T I O N 14 The PMHNP is preparing a community-based presentation for both the staff and residents of a local life-care facility. The facility offers a continuum of care from independent apartment living to assisted living to nursing home care. In an effort to increase awareness of signs and symptoms of dementia as compared to pseudo dementia, the management has contracted with the PMHNP to prepare these informative educational programs. When comparing and contrasting these two conditions, the PMHNP emphasizes that in pseudo dementia the patient is usually: -Very aware of the dysfunction -Afflicted by poor attention and concentration -Good at concealing disability -Joyful at accomplishing tasks Q U E S T I O N 15 Several medical disorders can produce symptoms of obsessive-compulsive disorder (OCD). Which of the following findings in a patient with new onset OCD should prompt an evaluation for a neurologic cause of symptoms? -Family history of neurological disease -Poorly controlled hypertension -Age 40 at presentation -Lack of response to SSRIs Q U E S T I O N 16 Which of the following is a true statement with respect to obsessive-compulsive disorder? -Most clinical drug trials support the hypothesis that dysregulation of the serotonergic system is involved in symptom formation -Between 50 and 75% of patients with obsessive-compulsive disorder (OCD) had premorbid obsessive-compulsive personality disorder (OCPD) -Behavioral theory suggests that development of obsessive thoughts and compulsive behaviors are a result of respondent conditioning -Most affected individuals are diagnosed between the ages of 25 and 40 Q U E S T I O N 17 Joyce is a 30-year-old female patient who was recently diagnosed with schizophrenia after being referred for mental health evaluation by the police. She demonstrated paranoid delusions that ultimately led to such disruptive behavior at her place of work that the police were called. Her husband was able to provide a history consistent with prodromal symptoms, and in retrospect her disorganized thought and poor insight were evident over the last few months. She was initially stabilized on IM Zyprexa (olanzapine) and has been maintained on oral Zyprexa for the last 2 weeks, and has been on 10 mg daily for 1 week. Today at follow-up she demonstrates mild improvement. Her hygiene and appearance are much improved. She is still hearing voices and has delusions that communists are trying to infiltrate the company for which she works. She is open to the idea that these are delusions but still seems hesitant to accept that premise. At this point her medication management should include: -Obtaining an olanzapine level -Increasing the dose of Zyprexa -Cross titrate another antipsychotic -Add a mood stabilizer Q U E S T I O N 18 Recurrent isolated sleep paralysis is characterized by the awareness of normal Remediated paralysis in the partially conscious state. It is a feature of normal REM sleep, and lifetime occurrence is estimated to be as high as 50%. While counseling patients about this condition, the PMHNP correctly states all the following except: -First-line therapy includes ensuring adequate sleep -Shift work can increase the likelihood that this occurs -People experience this should not be touched -It is among the tetrad of narcolepsy symptoms Q U E S T I O N 19 A wide variety of sleep-wake disorders are referred to the PMHNP for assessment and management. A contemporary approach to managing insomnia centers around: -Diagnosing and managing underlying causation -Providing relief and managing symptoms -Focusing on nonpharmacological therapies -Differentiating “tiredness” from “sleepiness” Q U E S T I O N 20 Trudy is a 49-year-old woman recently diagnosed with schizophrenia. While she has a strong family history of mood disorders, and has herself evidenced some depressive symptoms by history, her delusions and diagnosis of schizophrenia were a big surprise to herself and her family. She has been married for 25 years and by all accounts has had a successful marriage and family life until the last few months when she became increasingly concerned that her best friend was trying to seduce her husband. Further history suggests that she has paranoid delusions and that her memos from work carried messages that her coworkers were trying to destroy her family. Trudy was finally referred for care when she tried to attack a coworker. There is no apparent precipitating factor, and her family cannot understand why she is just now demonstrating symptoms of schizophrenia. Now that she is in treatment, which elements of her history support a good prognosis? -Lack of precipitating factors -Neurological signs -Physical assault -Age of onset Q U E S T I O N 21 Shireen is a 21-year-old transgender female who has been through an exhaustive counseling program and is ready to start hormone therapy with estrogen, progesterone, and testosterone-blocking agents. When counseling her specifically about the risks, benefits, and required monitoring of hormonal therapy, the PMHNP advises Shireen that: -Her ability to conceive will not be adversely impacted -There is a significant risk of developing benign prolactinomas -Smoking cigarettes while on estrogen therapy increases risk of thrombosis -If breast augmentation is planned, it should be performed prior to hormone therapy Q U E S T I O N 22 John is a 20-year-old male who is referred to treatment by his father. The two of them live together following the murder of John's mother 6 weeks ago. It was a tragic occurrence; John's mother was a nurse at an inner-city hospital and was killed as an innocent bystander in a drive-by shooting. John was very close to his mother, and in the last 3 weeks he has been increasingly distraught. His dad says he did not cope well from the beginning, but for the last 2 weeks he has been agitated, combative, and is hearing voices telling him that he could have saved his mother. He has become so agitated that his father brought him to the emergency room. The PMHNP knows that immediate treatment for John should include: -Electroconvulsive therapy -IM antipsychotics -Benzodiazepines -Antidepressants Q U E S T I O N 23 Gerry is a 24-year-old male who is being evaluated for obsessive-compulsive disorder (OCD). He has a long history of both obsessive thoughts and compulsive behaviors going back into mid-adolescence. When evaluating his history, the PMHNP knows that all of the following are more common in patients with OCD except -Celibacy -Tourette’s disorder -Marital discord -Obsessive-compulsive personality disorder Q U E S T I O N 24 Schizophrenia, schizoaffective disorder, and schizophreniform disorder are all among the continuum of psychiatric illnesses characterized by psychotic episodes. Which of the following clusters of features best distinguishes schizophreniform disorder? -prod Rome of negative symptoms, duration > 1 month, early age of onset -Absence of mood disorder, two or more psychotic symptoms, duration > 6 months -Progressive decline in social and occupational function, insidious onset, complete resolution of symptoms -Rapid and acute onset, return to baseline in < 6 months, occurs in adolescents and young adults Q U E S T I O N 25 Danny is a 19-year-old male who presents to the college mental health center at the insistence of his roommate. Danny has developed what his roommate calls an obsession with cleanliness. He showers several times a day and changes his clothes easily four or five times. He also brushes his teeth every couple of hours, convinced that he has bad breath. During the interview, it does not appear that these are anxiety-reducing rituals but rather he is certain that he has unpleasant body odors and needs to keep showering and brushing his teeth to get rid of them. While considering a diagnosis of obsessive-compulsive disorder, the PMHNP considers that differential diagnoses for Danny include all the following except: -Olfactory reference syndrome -Obsessive compulsive personality disorder -Temporal lobe epilepsy -Sinus inflammation Q U E S T I O N 26 Sarah is a 52-year-old female who is referred to psychiatric care by her primary care provider. Sarah clearly does not feel that the evaluation is necessary and indicates that she has essentially been "blackmailed" by her long-time primary care provider who says he will no longer see Sarah until she has a mental health assessment. The referring PCP reports that Sarah is convinced that she has a cancer that he cannot diagnose. Sarah's mother, brother, and sister all died from various cancers, and Sarah has become convinced that she has one too, although no one can find it. A genetic evaluation indicates no genetic or familial risk. Sarah has had a thorough physical examination; been screened for colorectal, breast, and cervical cancer; and has also had CT scans of the head and chest; the last two at her request as her mother and brother had brain and lung cancer, respectively. Sarah has no specific symptoms but is fixed in the belief that she has cancer that no one can find. When considering a diagnosis of delusional disorder, the PMHNP would expect Sarah's evaluation to reveal: -Mental status examination is normal -Hallucinations consistent with occult cancer -A willingness to consider objective evidence that her belief is unrealistic -Family history of psychotic or mood disorder Q U E S T I O N 27 Obsessive compulsive disorder is characterized by variable success to treatment, presenting on a bell-curve continuum. Twenty to 30% of patients have significant improvement, 40- 50% have moderate improvement, and 20-40% remain ill or even develop worsening symptoms. Which of the following is best correlated with the most optimistic treatment outcomes? -Childhood onset -Yielding to compulsions -Precipitating event -Some acceptance of symptoms Q U E S T I O N 28 Which of the following infectious diseases associated with psychiatric symptoms is most likely to present with olfactory and gustatory hallucinations, psychosis, personality changes, and partial seizures? -Rabies encephalitis -Neurosyphilis -Lyme disease -Herpes simplex encephalitis Q U E S T I O N 29 Ron D. is a 67-year-old man who has been referred by his primary care provider for management of sleep disorder. He has seen his PCP many times complaining of insomnia. He reports that he lays in bed for "hours" every night before falling asleep and then often wakes up every 90 minutes, sometimes staying awake for more than an hour before he goes back to sleep. He has been trialed on both zolpidem (Ambien) and zaleplon (Sonata) without improvement. Polysomnography did not support the pattern of sleep described by Ron D. During his sleep study, he reported the same complaints; while the objective test results indicated that he fell asleep in < 15 minutes with a total sleep time > 7 hours and 93% sleep efficiency. This is known as -Psychophysiological insomnia -Conditioned insomnia -Paradoxical insomnia -Idiopathic insomnia Q U E S T I O N 30 A secondary prevention strategy to reduce the incidence of pedophilia includes: -Participating in community awareness programs and promoting identification of sexual offenders in the neighborhood -Designing a screening tool to identify children 13 years of age and younger at high risk for being targeted by pedophiles -Volunteering one afternoon a week to counsel in a comprehensive center for children who have been victimized -Researching strategies to promote best long-term success treatment modalities Q U E S T I O N 31 Mrs. Swenson is a 71-year-old patient who has been referred to mental health services for evaluation and management of dementia. She recognized her own cognitive deficits and discussed them with her primary care provider, who advised that she seek specialty care. After performing a comprehensive assessment, the PMHNP diagnoses the patient with vascular dementia. While reviewing her medication list from the PCP, the PMHNP recognizes that which of the following medications may be contributing to Mrs. Swenson's cognitive impairment? -Metformin (Glucophage) -Clopidogrel (Plavix) -Metoprolol (Lopressor) -Lisinopril (Lotensin) Q U E S T I O N 32 What is the primary difference between sexual interest and arousal disorders in men and women? -Unlike men, women may not feel interest or desire until after arousal -The disorder rarely occurs in older men but is common in older women -Symptoms occur more commonly due to hormone deficiencies in men -Duration of symptoms to support diagnosis is longer in women Q U E S T I O N 33 The clinical evaluation of neurocognitive disease includes a detailed assessment of cognition. Which of the following aspects of cognitive testing may result in false positives due to poor education or low intelligence? -Memory -Visuospatial ability -Reading and writing ability -Abstraction Q U E S T I O N 34 Maryanne is a 26-year-old female who is in therapy for obsessive compulsive disorder. She was trialed on SSRI therapy without remission and was changed to clomipramine, 25 mg q.h.s. titrated up to 100 mg q.h.s. 2 weeks ago. She presents today for follow up. The PMHNP assesses for which of the following adverse effects? -Diarrhea -Bradycardia -Sedation -Urinary incontinence Q U E S T I O N 35 All of the following strategies are used successfully to manage paradoxical insomnia except: -Cognitive relabeling -Diffusing sleep worry -Anxiolytics -Changing environment Q U E S T I O N 36 The PMHNP is preparing a presentation for a primary care conference. The topic is "Recognizing Schizophrenia: Common Signs and Symptoms Encountered by the Primary Care Provider." A critical point to stress to primary care clinicians is that: -Olfactory and gustatory hallucinations are unusual and should prompt evaluation for a neurological disorder -A praecox feeling as correlated with a diagnosis of schizophrenia has a demonstrated sensitivity of 83% -Disorders of thought content are pathognomonic for schizophrenia and are an indication to begin antipsychotics -Premorbid and prodromal signs and symptoms have a high predictive validity and should prompt a psychiatric referral Q U E S T I O N 37 The PMHNP is formulating a diagnosis for Peter, a 24-year-old man who was admitted for management of acute psychoses. He believed that he was the Holy Ghost of the Christian Trinity. According to his mother and father, he did not have any psychiatric symptoms or history throughout childhood and adolescence, but after college, he began to develop "issues" characterized by extremes of mood in which he would be too depressed to attend classes for weeks at a time followed by a rebound in which he would go partying, stay awake for days at a time, and go on ridiculous shopping sprees. When considering a diagnosis of schizoaffective disorder, the PMHNP attempts to establish that: -His religious delusions are of at least 4 weeks’ duration and have produced social or occupational impairment -The delusions at some point have occurred for 2 weeks absent a major mood episode -Symptoms respond favorably to a combination of antipsychotic medications and mood stabilizers -There is evidence of premorbid or prodromal symptoms prior to the psychotic episode Q U E S T I O N 38 Catatonia is an uncommon finding most often related to -Schizophrenia -Major depressive episode -General medical condition -Parkinsonism Q U E S T I O N 39 Luz is a 24-year-old female who is being evaluated at the strong urging or her mother and the family primary care provider. According to the mother, Luz has been progressively demonstrating obsessive thoughts and compulsive behaviors centering on religion. She is preoccupied with the concept of heaven and hell, and she often becomes very distressed that she is going to go to hell when she dies. The mother also reports that Luz appears to be compulsive about reading her Bible and performing prayers and other rituals several times a day. The PMHNP must perform a detailed history and examination to differentiate obsessive-compulsive disorder (OCD) from: -Obsessive compulsive personality disorder -Psychosis -Depression -Schizoid personality disorder Q U E S T I O N 40 Dual-sex therapy is a therapeutic approach to sexual dysfunction in a marital dyad or relationship that is believed to result from disharmony or misunderstanding in the relationship. This is most effective in couples when: -The therapeutic team takes the lead in directing activities -There is no other psychopathology in either partner -Individual therapy for the partner with the dysfunction is unsuccessful -Each partner comes to therapy with an open mind to sexual play Q U E S T I O N 41 John is a 19-year-old male who is self-referred for care after being prematurely discharged from the military. He is vague as to the details of his discharge, but it appears he had difficulty with performance evaluations and was apparently arrested for several incidences of illegal substance abuse. Comprehensive evaluation of John reveals that he thinks he "is really a woman," but he cannot accept this and joined the Army to try and "be a real man." John indicates that he has always felt like he was really a girl, and he says that he "hates that he has a penis." When considering a diagnosis of gender dysphoria, the PMHNP knows that which of the following would be most consistent with John's history? -He is only sexually attracted to men -He has a desire for gender reassignment surgery -Cross-gender behavior was evident before puberty -John is unable to obtain an erection with partners of either gender Q U E S T I O N 42 Kasey is a 26-year-old male who is referred for emergency psychiatric evaluation in the local community emergency room. His girlfriend came home from work unexpectedly and found him in the bathtub with multiple longitudinal cuts on both wrists. She called 911 and he was stabilized in the ED; the injuries were not serious, and now he is pending psychiatric evaluation. When the PMHNP came into the room, he noticed that Kasey unbuttoned and rebut toned his shirt four times before settling down to the interview. He presented as depressed and tearful, and admitted to feelings of hopelessness and worthlessness. He admits that he doesn't really feel connected to anyone; he has always been a loner, and last night he tried to kill himself because life just was not worth living. In addition to his suicidal ideation, the PMHNP recognizes that he needs to be further evaluated for: -Major depressive episode and obsessive- compulsive disorder -Bipolar disorder with psychotic features -Dysthymia and borderline personality disorder -Obsessive compulsive disorder and schizoid personality disorder Q U E S T I O N 43 Jack is a 19-year-old male who is being treated for obsessive-compulsive behavior. He has just begun his mission as a member of the Church of Jesus Christ of Latter Day Saints, and his partner has encouraged him to come to care due to his compulsive cleaning behaviors. Jack has had a very difficult time with treatment; after several sessions, it is apparent that he is having obsessive sexual thoughts with which he is not comfortable. Jack would like to avoid pharmacotherapy if he can, and is interested in exploring psychotherapeutic interventions. The PMHNP refers Jack to therapy and discusses with him that the psychodynamic theories of OCD include: -Intolerance of the nuclear family to compulsive rituals -The drive to seek secondary gain because of compulsive behavior -Abnormalities related to the anal-sadistic phase of development -A disproportionate ratio of concomitant personality disorders Q U E S T I O N 44 Jaime is a 19-year-old woman who is in psychiatric care as a condition of probation. She first came to the attention of the juvenile detention system when she was 15 years old. She was babysitting for a neighbor, and the parents came home early and found that she was exposing her breasts to the 9-year-old child in her care. Since then she has had several similar episodes, and since turning 18, she has been arrested several times for exposing herself to children and teenagers. During her evaluation, she admits that the only way she can experience arousal and orgasm is to engage in this behavior and then masturbate afterward. She has had more conventional sexual experiences but does not enjoy them. When considering a diagnosis of paraphilic disorder, the PMHNP recognizes that which of the following features is inconsistent with the typical paraphilic disorder patient? -The subtype; exhibitionism is a very uncommon form of paraphilia -The fact that Jaime is female; almost all patients with paraphilia are male -The inability to experience arousal or orgasm any other way -The onset before age 18 Q U E S T I O N 45 R.M. is an 81-year-old male who was evaluated at his own request because of his failing memory. He is an active older adult and has enjoyed a comfortable retirement lifestyle, but over the last year he has become increasingly troubled by his forgetfulness. His wife agrees that it has extended beyond the occasional memory lapse; he forgets names of things he should know and has forgotten commitments to friends and family. After a thorough evaluation, the PMHNP diagnoses mild cognitive impairment (MCI). R.M. asks if this is really Alzheimer's disease, if it is going to get worse, and what can he do about it? The most appropriate response would be to tell R.M. that: -His cognitive function will likely decrease 10–15% per year -The diagnosis is not stable and he may revert to normal function -Cholinesterase inhibitors, such as donepezil, will improve memory but not cure the condition -There is no identified link between mild cognitive impairment and Alzheimer’s dementia Q U E S T I O N 46 Trayvon is a 28-year-old male who was recently discharged from the military as a result of some behavioral issues leading to early termination. He was never in a combat situation, and his behavior and anger seem to predate his military enlistment. He is only in care because the military offers this as a transitional service, and Trayvon thinks it will help him be successful with future job applications. During a comprehensive evaluation of Trayvon, the PMHNP realizes that, among other things, he is experiencing postictal dysphoria. Predictably this is causing some problems with his girlfriend, and he asks if there is anything he can take to help. The PMHNP advises that: -Antianxiety agents have been successful in some patients -This is most often due to issues in the relationship and dual-sex therapy is indicated -Insight-oriented psychotherapy is necessary to help him identify unconscious antecedents to his behavior -This is probably one symptom of an underlying personality disorder and requires treatment of the primary problem Q U E S T I O N 47 In addition to the diagnostic criteria observed in patients with schizophrenia, physical examination of these patients is frequently characterized by: -Hyperreflexia -Saccadic movement -Rheumatoid arthritis -Type 1 diabetes mellitus Q U E S T I O N 48 D.M. is a 21-year-old male who presents for admission with his mother. He reports that he "cannot get himself together." He is disoriented x 3 and his thought processes are chaotic. His speech is disorganized, he is easily distracted, and he appears to be rather agitated. He admits to both visual and auditory hallucinations over the last few weeks, and says he can "hear through the walls." He was unable to sit still during the evaluation, often getting up and pacing the room, looking out of the windows, and then appearing to listen to something no one else could hear. According to his mother, his behavior has been bizarre for weeks; he has been wandering the neighborhood aimlessly, and reports that he was raped by a male neighbor. His mother finally brought him to the hospital. He appears unaware of his circumstances. D.M. is a poor historian, but does admit to drug and alcohol use on and off for several years. According to his mother, he had a scholarship to college, but it was withdrawn last semester when he stopped going to classes. A screening laboratory assessment is within normal limits, and the PMHNP considers a diagnosis of schizophrenia. D.M.'s presentation is most consistent with which type? -Paranoid -Disorganized -Undifferentiated -Catatonic Q U E S T I O N 49 Corny has been referred to the PMHNP because she has a significant sleep disorder that has not been responsive to typical primary care strategies. She has tried sedative hypnotics, improving sleep hygiene, avoiding daytime naps, melatonin, and almost anything else suggested. She has always had trouble sleeping "like normal people," but she is newly married and her sporadic sleep patterns are beginning to cause stress in the marriage. Her history suggests a circadian rhythm sleep disorder. When counseling Coryn, the PMHNP advises her that all the following strategies have demonstrated success except: -Chronotherapy -Phototherapy -Tasimelteon -Zaleplon Q U E S T I O N 50 When evaluating the patient with dementia, the PMHNP recognizes that one of the clinical differences between cortical and subcortical dementias is that in subcortical dementia an early finding will typically not include which of the following? -Impaired visuospatial skills -Depressed mood -Dysarthria -Aphasia [Show Less]
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