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NURS 6670
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NURS 6670 MID-TERM EXAM-QUESTIONS AND ANSWERS (VERIFIED). Latest.
NURS 6670 MID-TERM EXAM-QUESTIONS AND ANSWERS (VERIFIED). Latest. Question 1 Alexa is a 27-year-old female who has come to group therapy while she is in... [Show More] the city jail. She was arrested 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 sentenced 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 fired 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 extended for 30 days because she got into a fight with another inmate and beat her up so badly she had to be admitted to the hospital for 6 days. The PMHNP considers which of the following personality disorders? a) Histrionic b) Narcissistic c) Borderline d) Schizoid Question 2 Anne is a 32-year-old female who presented 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 admitted 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: a) The physiologic symptoms of withdrawal may require a short-term hospitalization b) Unlike other substances of abuse, there are no medications to help reduce the intensity of withdrawal c) She will need to be monitored for depression d) Overcoming the intense craving for cocaine is the biggest issue Question 3 Clare’s history of personal relationships is characterized 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 livein 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: a) Has disproportionate anger toward an abusive spouse Question 4 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 be centered upon the patient’s: b) Clothing c) Speech pattern d) Anger e) Anxiety Question 5 A PMHNP student is reviewing his notes from his clinical experience over the past week to prepare his first required 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? a) A 27-year-old female with a 1-month history of social withdrawal, anorexia, hypersomnia, unprovoked outbursts of anger, and a strong family history of endogenous depression. b) A 41-year-old male with a history of childhood sexual abuse, loss of interest in both his professional and personal life, an unplanned 10 lb. weight loss in the last 3 months, and perceptual disturbances. c) A 65-year-old male whose wife died 2 months ago and he reports a 3-week history of generally depressed mood, guilt about his wife’s death, insomnia, difficulty focusing on daily tasks, with increasing thoughts of dying. d) A 72-year-old female who just relocated across country to live with her adult son and daughter-in-law who is despondent about leaving her home and reports forgetfulness, loss of appetite, new onset bowel problems, and extreme loss of energy. Question 6 A variety of pharmacologic agents have demonstrated effectiveness in the treatment of post-traumatic stress disorder. Which of the following does not have any evidenced-based support in the literature? a) SSRIs b) TCAs c) Antiadrenergic d) Antipsychotics Question 7 The PMHNP is on call at the local county correctional facility. He is asked to evaluate M.S., a 21-year-old male who was just arrested 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 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 happened 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: a) Stuttered b) Increased c) Childlike d) Confused Question 8 Fletcher is a 29-year-old male referred for court-ordered counseling. He has a long history of repeated 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 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-adjusted. 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 started drinking heavily; it was ―all downhill from there.‖ The PMHNP considers that: a) History and symptoms are most consistent with antisocial personality disorder b) Fletcher needs a neurological workup to include an EEG and assessment for neurological soft signs c) Consistent with his symptoms, Fletcher will likely respond well to a stress interview d) It is likely that substance abuse is the underlying cause of symptoms and should be explored further Question 9 Which among the following neurotransmitters is decreased in depression and increased in mania? a) Dopamine b) Norepinephrine c) Serotonin d) Glutamate Question 10 Among the various types of therapeutic intervention for patients with borderline personality disorder, which of the following is characterized 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? a) Mentalization-based treatment (MBT) b) Transference-focused psychotherapy (TFP) c) Countertransference-focused psychotherapy (CTFP) d) Dialectical behavioral therapy (DBT) Question 11 Mr. Kendall is a 47-year old male who is presented to care by his younger sister, Megan. Mr. Kendall has spent his entire adult life living in an apartment that was attached 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 considered odd all his life, has never married or even dated as far as Megan knows, but she had no idea how odd he was. When his mother died, he seemed disconnected 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? a) A history of schizophrenia of a first-degree relative b) Sustained psychosis predating his mother’s death c) Comorbid Asperger’s syndrome d) Apparent frank thought disorder Question 12 Which of the following is a true statement with respect to the treatment of narcissistic personality disorder? a) Psychoanalytic psychotherapy has strong empiric support b) Both serotonergic drugs and lithium are useful c) Group therapy is rarely helpful d) Immobilized patients (hospitalized or incarcerated) have the best outcomes Question 13 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 described as a life-long ―loner.‖ In high school and college, he kept to himself, excelling in his studies in the sciences. Currently described 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: a) Schizoid personality disorder b) Schizotypal personality disorder c) Paranoid personality disorder d) Delusional disorder Question 14 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: a) A history of racing thoughts b) Difficulty interacting with others c) Extremely high expectations of self d) Significant impairment at work 7 Question 15 Hugo is a 39-year-old male who has encouraged his wife to come to counseling because he is worried 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 worried 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 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: a) Hugo’s wife meets diagnostic criteria for this disorder b) A trial period with no wine ingestion is necessary to assess for withdrawal symptoms c) The family history should be assessed for genetic tendency d) Hugo may have unreasonable expectations Question 16 When developing a pharmacologic treatment plan for the management of major depressive disorder, the PMHNP counsels the patient that the medication will be titrated up to the appropriate dose and then continued for a minimum of 3 months; medication must not be stopped abruptly or without provider supervision. This is because the physiologic consequence of abrupt cessation is likely to result in: a) Antidepressant discontinuation syndrome b) Rebound depressive symptoms c) A manic or hypomanic episode d) Unresponsiveness to medication with future episodes Question 17 Which of the following is a true statement with regard to the etiology of substance abuse? a) Neurotransmitters or receptors have been identified with most substances of abuse except for alcohol b) Twin and sibling studies do not support a genetic component with respect to the etiology of substance abuse c) Substances of abuse decrease activity in the amygdala and anterior cingulate d) The WHO schematic of drug use and dependence identifies immediate antecedents as the central element of abuse Question 18 Assessment of the manic state in a patient with bipolar disorder is likely to include all the following except: a) Mood-congruent delusions of grandeur b) Suicidal or homicidal ideation c) Impaired judgment with no insight d) Unrestrained flow of ideas Question 19 When performing a psychiatric assessment of an elderly patient with Alzheimer’s dementia, the PMHNP recognizes that: a) An important part of the history will come from the caregiver b) The patient must also be interviewed alone to preserve privacy of the relationship c) A sexual history is not necessary in patients who are not sexually active d) All of the above. Question 20 Jeffrey T. is a 27-year-old man who has presented for care after being required 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 intoxicated. He is a bit resentful at being required to attend therapy; he is very vocal that his driving was not impaired 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: a) Dependence b) Abuse c) Adaptation d) Addiction Question 21 Danielle is a 31-year-old female who is having a psychiatric evaluation at the insistence of her husband. They have been married for 4 years, and her husband has finally become so frustrated 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: a) Diazepam b) Pimozide c) Psychotherapy d) Group therapy Question 22 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 stopped 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 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 affected her physical health at all. While counseling Margo about alcohol withdrawal delirium (delirium tremens), the PMHNP advises Margo that: a) She should be admitted for inpatient detoxification b) People in good physical health rarely have DTs c) A beta adrenergic antagonist medication can minimize her risk of DTs d) Women rarely experience DTs Question 23 Anthony is a 41-year-old male patient who presents for evaluation. His wife made the appointment because she is worried 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 evaluated by his primary care provider and has no apparent medical conditions. His wife reports that he has been diagnosed with depression in the past, and has even taken medication that seemed to help. This time he just refused 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: a) Venlafaxine and clozapine b) Fluoxetine and olanzapine c) Amitriptyline and haloperidol d) Paroxetine and buspirone Question 24 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 committed to the marriage and loves her husband, but finds his inflated 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 embarrassed by that. While counseling Marlene, the PMHNP advises her that patients with narcissistic personality disorder have extremely fragile: a) Sense of self-importance b) Defense mechanisms c) Self-esteem d) Interpersonal relationships Question 25 Marie is a 30-year-old woman who presents for follow-up after starting treatment for bipolar disorder. She had been treated on and off for depression for years and had a history of alcohol abuse. After her marriage, she decided 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 started on a mood stabilizer 1 month ago. She tolerated 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: a) Discontinuing medication presents a marked risk of return to alcohol b) A program of psychotherapy should be started before stopping medication c) She needs to continue medication for a minimum of 3 months d) Cessation of mood stabilizers prematurely increases risk for a depressive episode Question 26 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 considered the standard for assessing clinical outcomes in treatment studies of schizophrenia? a) SCID b) BPRS c) PANSS d) HAM-D Question 27 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? a) Eye movement desensitization and reprocessing therapy b) Implosive therapy c) Systematic desensitization d) Relaxation and cognitive techniques Question 28 A 22-year-old male patient is started on sertraline 50 mg p.o. daily after presenting with a major depressive episode. After tolerating without difficulty for 2 weeks, his dose is increased 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: a) When symptoms are preceded by antidepressant therapy, a diagnosis of bipolar does not apply b) His symptoms may be consistent with bipolar disorder if they persist for at least 2 weeks c) A formal assessment of the social and occupational implications of his symptoms should be performed d) The symptoms are most likely a physiologic adaptation to the sertraline and most often normalize Question 29 The PMHNP is seeing a patient who has been referred by primary care. The patient was diagnosed with major depressive disorder and trialed 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 detailed 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: a) Lamotrigine b) Valproic acid c) Lithium d) Amitriptyline Question 30 Mariel is a middle-aged woman who is referred 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 moved away from home she will need to be more independent and is very committed to trying to manage her fear. The PMHNP counsels Mariel that the most successful therapy for phobic disorders is: a) Insight-oriented psychotherapy b) Behavior therapy c) Virtual therapy d) Pharmacotherapy Question 31 Cannabis intoxication delirium is characterized by all of the following except: a) Impaired memory b) Perception c) Psychosis d) Motor coordination Question 32 Tim is a 20-year-old male who has been referred for care by his college counselor. The counselor has noted 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: a) Avoidant personalities have a strong desire for personal relationships b) Avoidant personalities may have an active fantasy life c) Schizoid personalities are perceived as distant and aloof d) Schizoid personalities may be very attached to animals Question 33 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 worked 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 asked why he thinks he will be homeless, he responds by talking about how many hours he has worked 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: a) Affect b) Cognition c) Thought process d) Abstract reasoning Question 34 Cory is a 23-year-old male recently incarcerated 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 required 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 [Show Less]
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NURS 6670 FINAL EXAM STUDY GUIDE CHAPTER 1 TO 39
NURS 6670 FINAL EXAM STUDY GUIDE CHAPTER 1 TO 39 Case Study, Mohr: CHAPTER 1, Introduction to Psychiatric–Mental Health Nursing 1. Karen is a 25-y... [Show More] ear-old white woman who lives alone in an apartment with her dog. Karen has been divorced for 2 years and is taking Prozac prescribed by her psychiatrist for depression. Karen and her boyfriend had been discussing marriage until he told her that he wanted to end their relationship. Karen became even more depressed and could not work for a week. Karen returned to work, refusing to discuss her issues with family, friends, or coworkers. She did, however, make an appointment to see a psychiatric nurse practitioner. Karen told the nurse that she was making some changes in her life. Karen said that she and a girlfriend were joining a gym program for workouts and a social group for young men and women. Karen stated that she realizes that her former boyfriend had not been committed to her, and she anticipates meeting and dating other young men from the adult social group. Karen also said that she thinks that the gym exercise will be beneficial to her mentally and physically. Learning Objectives: 1, 4) a. How will the psychiatric nurse assess if Karen has made progress toward self-realization? Karen had suffered from depression which is a form of mental disorder as a result of divorce and a broken relationship with her boyfriend. This situation according to Hypocriticus in 15th century BC, upholds the brain as the organ of consciousness; this occurs when both normal and abnormal behavior arise from the brain. The psychiatric nurse can assess if Karen has made progress towards self-realization by committing to diagnosing and treating her responses to the problems that caused her psychiatric disorder. In-addition, the nurse can make assessment based on Karen’s psychoanalytical disposition such as: trasferrence, defense mechanism, countertransference, acting out, denial of the reality befallen her and projection. b. Identify strengths that Karen has for progress in personal growth. The strengths Karen has for progress in personal growth include the followings: • Ability to make use of social support, that is, she visited a psychiatric nurse, social group and registered in a gym. • She was realistic about her situation, therefore made herself ready to face the reality before her. • Karen sought immediate medical attention where she was administered with Prozac to help mitigate her depression state. • Her cognitive behavioral responses showed optimism towards a better life as well as fighting against her depressed state. Hence, her willingness to date younger men. c. Karen has been seeking treatment for her depression. Analyze the factors that might contribute to Karen’s reluctance to discuss her depression with others. Karen’s reluctance to discuss her depression with others hinges on the fact that her depression was a kind called social depression. Social depression is a psychological disorder caused by several factors such as: interpersonal relationship which involves the relationship between a person and the interactions of emotions of each individual expressed directly and discreetly to each other. Another is a Common interpersonal relationship, this includes: Family, social environment (work place), and interaction among age groups and genders. Because Karen had divorce and broken relationship, she didn’t feel safe in herself discussing her depression with family and friends but to seek a professional whose job is to attend to her depressed case. Hence, her neuroticism was calm and strong willed. Case Study, Mohr: CHAPTER 2, Neuroscience: Biology and Behavior 1. Michael is a 22-year-old college senior whose GPA has declined with this semester’s grades. Michael plans to apply to medical school and thinks that the lower GPA may prevent his acceptance to medical school. For the last 2 weeks, Michael has skipped most classes because he has insomnia and fatigue. Michael is now very depressed and has been thinking of suicide. He took a loaded gun from his father’s gun cabinet and then wrote a suicide note to his family. At the last moment, he telephoned 911 and told them of his suicide plan. The police came, took the gun away, and then took Michael to the city hospital to be admitted for psychiatric treatment. In the admission interview with the psychiatric nurse, Michael said that his pastor thought that only weak-willed people experienced depression and that it was a punishment for personal sins and the sins of one’s ancestors. Michael told the nurse that he must be weak-willed and will never be able to accomplish anything. The psychiatric nurse explained that multiple factors are the cause of depression. The nurse told Michael that one theory holds that an imbalance of neurotransmitters, or chemical messengers of the brain, occurs in depression. Neurotransmitters influence the individual’s emotions, thoughts, and subsequent behavior. Recent research implies that neurobiology, heredity, as well as Psychological and environmental factors may be involved in the development and progression of depression. (Learning Objectives: 5, 6) a. Will Michael think that the psychiatric nurse’s explanation for the cause of depression is more correct than that of his pastor? No. It is indeed difficult for Michael to accept the doctor’s opinion since before he fell sick, he had information from the pastor on depression on which he solely believed and now he is a living prove. b. Michael asks the nurse why he has to have psychotherapy. He states that he only needs to take a couple of pills to get better. How should the nurse respond to Michael’s question and comment? The nurse has to explain to Michael why he should consider psychotherapy. Because of the many misconceptions about psychotherapy, you may be reluctant to try it out. Even if you know the realities instead of the myths, you may feel nervous about trying it yourself. Overcoming that nervousness is worth it. That’s because any time your quality of life isn’t what you want it to be, psychotherapy can help. Taking only pills will not help but increase the effects because most of these medication have side effects which would have been avoided by psychotherapy. c. Develop an assessment question for each of the following possible causes of Michael’s development of depression: Genetic, Environment and Stress. From the Geriatric Depression Scale: “Do you prefer to stay at home rather than going out and doing new things?” This question asks for a yes or no answer and recognizes that isolation and withdrawal are common signs of depression — especially in the elderly. From the MADRS: “How is your sleep?” Answers include: Sleeping as usual, slight difficulty, sleep reduced by at least two hours, or getting less than three hours of sleep at night. Greater sleep disturbance signals a greater risk for depression. From the Beck Depression Inventory: “How is your energy?” Declines in energy level are a common sign of depression — the more significant your lack of energy, the higher your depression risk rating. Possible answers to this question include: As much energy as ever, less energy than before, not enough to do much, or not enough to do anything Case Study, Mohr: CHAPTER 3, Conceptual Frameworks and Theories. 1. The student nurse has been assigned a 37-year-old woman admitted to the psychiatric hospital with an anxiety disorder. This morning, the student notices that the client has a tense facial expression and is walking constantly around the group room. The student walked over to the client and used reflective communication by stating, “I see that you have a tense expression and are walking around almost all of the time. Is there something that we could discuss?” The client replied that she has talked on the telephone to her mother who was keeping her children while she was in the hospital. The client said that her mother had told her that she was not a good mother, and then said, “I guess I am a bad mother, but I could never measure up to my mother’s expectations.” The student has learned that negative self-talk can greatly aggravate anxiety and lead to depression. The student decided to use a behavioral intervention with the client and asked the client who is a good artist and why the client liked the artist’s works. The student and the client then made a list of activities that the client liked. The student taught the client to engage in one of these activities when an unpleasant experience evoked negative thoughts. The following day, the student decided that the client needed some cognitive restructuring for her relationship with her mother. The student taught the client that during discussions with her mother, feelings of incompetence might be experienced when the mother made negative comments. The client was instructed that if her mother made negative comments about parenting, she was to immediately tell her mother that she was a good parent to her children and terminate the conversation at the first opportunity. (Learning Objective: 3) a. Will the client be able to learn cognitive restructuring in her relationship with her mother? Yes, she will learn because by keeping positive thought, her cognitive restructure will develop to the positive. Based on the above facts and behavioral intervention made between client and the student nurse it is possible to established a good and collaborative relationship with her mother. Besides, client can also be able to gain of cognition to maintain a fruitful relationship with her mother. [Show Less]
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NURS 6670 Midterm Exam Questions and Answers
NURS 6670 Midterm Exam Questions and Answers NURS 6670 Midterm Exam Questions and Answers Question 1 Histrionic Narcissistic Border... [Show More] line Schizoid Question 2 The physiologic symptoms of withdrawal may require a short-term hospitalization Unlike other substances of abuse, there are no medications to help reduce the intensity of withdrawal She will need to be monitored for depression Overcoming the intense craving for cocaine is the biggest issue Clare’s history of personal relationships is characterized 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: Has disproportionate anger toward an abusive spouse Question 4 Clothing Speech pattern Anger Anxiety Question 5 A 27-year-old female with a 1-month history of social withdrawal, anorexia, hypersomnia, unprovoked outbursts of anger, and a strong family history of endogenous depression A 41-year-old male with a history of childhood sexual abuse, loss of interest in both his professional and personal life, an unplanned 10 lb. weight loss in the last 3 months, and perceptual disturbances A 65-year-old male whose wife died 2 months ago and he reports a 3-week history of generally depressed mood, guilt about his wife’s death, insomnia, difficulty focusing on daily tasks, with increasing thoughts of dying Question 6 SSRIs TCAs Antiadrenergics Antipsychotics Question 7 Stuttered Increased Childlike Confused Question 8 History and symptoms are most consistent with antisocial personality disorder Fletcher needs a neurological workup to include an EEG and assessment for neurological soft signs Consistent with his symptoms, Fletcher will likely respond well to a stress interview It is likely that substance abuse is the underlying cause of symptoms and should be explored further Question 9 Which among the following neurotransmitters is decreased in depression and increased in mania? Dopamine Norepinephrine Serotonin Glutamate Question 10 Mentalization-based treatment (MBT) Transference-focused psychotherapy (TFP) Countertransference-focused psychotherapy (CTFP) Dialectical behavioral therapy (DBT) Question 11 A history of schizophrenia of a first-degree relative Sustained psychosis predating his mother’s death Comorbid Asperger’s syndrome Apparent frank thought disorder Question 12 Which of the following is a true statement with respect to the treatment of narcissistic personality disorder? Psychoanalytic psychotherapy has strong empiric support Both serotonergic drugs and lithium are useful Group therapy is rarely helpful Immobilized patients (hospitalized or incarcerated) have the best outcomes Question 13 Schizoid personality disorder Schizotypal personality disorder Paranoid personality disorder Delusional disorder Question 14 A history of racing thoughts Difficulty interacting with others Extremely high expectations of self Significant impairment at work Question 15 Hugo’s wife meets diagnostic criteria for this disorder A trial period with no wine ingestion is necessary to assess for withdrawal symptoms The family history should be assessed for genetic tendency Hugo may have unreasonable expectations Question 20 Dependence Abuse Adaptation Addiction Question 16 Antidepressant discontinuation syndrome Rebound depressive symptoms A manic or hypomanic episode Unresponsiveness to medication with future episodes Question 17 Which of the following is a true statement with regard to the etiology of substance abuse? Neurotransmitters or receptors have been identified with most substances of abuse except for alcohol Twin and sibling studies do not support a genetic component with respect to the etiology of substance abuse Substances of abuse decrease activity in the amygdala and anterior cingulate The WHO schematic of drug use and dependence identifies immediate antecedents as the central element of abuse Question 18 Assessment of the manic state in a patient with bipolar disorder is likely to include all the following except: Mood-congruent delusions of grandeur Suicidal or homicidal ideation Impaired judgment with no insight Unrestrained flow of ideas Question 19 An important part of the history will come from the caregiver The patient must also be interviewed alone to preserve privacy of the relationship A sexual history is not necessary in patients who are not sexually active All of the above. Question 21 Diazepam Pimozide Psychotherapy Group therapy Question 22 She should be admitted for inpatient detoxification People in good physical health rarely have DTs A beta adrenergic antagonist medication can minimize her risk of DTs Women rarely experience DTs Question 23 Venlafaxine and clozapine Fluoxetine and olanzapine Amitriptyline and haloperidol Paroxetine and buspirone Question 24 Sense of self-importance Defense mechanisms Self-esteem Interpersonal relationships Question 25 Discontinuing medication presents a marked risk of return to alcohol A program of psychotherapy should be started before stopping medication She needs to continue medication for a minimum of 3 months Cessation of mood stabilizers prematurely increases risk for a depressive episode Question 26 SCID BPRS PANSS HAM-D Question 27 Eye movement desensitization and reprocessing therapy Implosive therapy Systematic desensitization Relaxation and cognitive techniques Question 28 When symptoms are preceded by antidepressant therapy, a diagnosis of bipolar does not apply His symptoms may be consistent with bipolar disorder if they persist for at least 2 weeks A formal assessment of the social and occupational implications of his symptoms should be performed The symptoms are most likely a physiologic adaptation to the sertraline and most often normalize Question 29 Lamotrigine Valproic acid Lithium Amitriptyline Question 30 Insight-oriented psychotherapy Behavior therapy Virtual therapy Pharmacotherapy Question 31 Cannabis intoxication delirium is characterized by all of the following except: Impaired memory Perception Psychosis Motor coordination Question 32 Avoidant personalities have a strong desire for personal relationships Avoidant personalities may have an active fantasy life Schizoid personalities are perceived as distant and aloof Schizoid personalities may be very attached to animals Question 33 Affect Cognition Thought process Abstract reasoning Question 34 Have a family history of the same disorder Respond well to dialectical behavioral therapy Have impaired emotional defense mechanisms Come from smaller nuclear families Question 35 An acute change in mental status Angry verbal outbursts that seem unwarranted Death of her best friend An unplanned weight loss despite consistent oral intake Question 36 Psychoanalytic Behavioral Existential Cognitive Question 37 An SNRI will likely be the most appropriate choice if pharmacotherapy is indicated for this episode This may be an inaccurate characterization, as depressed patients tend to overemphasize negatives In some circumstances patients will purposefully mischaracterize the efficacy of medications they feel were ineffective Some forms of recurrent depression are best managed with nonpharmacologic strategies Question 38 The treatment of dependent personality is rarely successful Occupational dysfunction is rarely impaired Dependent personalities tend to have long-term relationships with one person This disorder tends to be more common in men Question 39 The physiologic stress accompanying her first episode of depression may have produced changes in brain biology that makes her susceptible to subsequent episodes without an external trigger The pharmacotherapy required to achieve remission with her first episode resulted in neuroplastic changes that increased her likelihood of experiencing additional depressive episodes The scientific literature suggests that the loss of a sibling is the life event most closely associated with recurrent episodes of major depressive disorder throughout adulthood Response to pharmacotherapy often takes a minimum of 8 weeks and that M.T. is much more likely to achieve remission if he can continue to provide the necessary support throughout her remission period. Question 40 A thorough physical examination A family history of mental health disease A urine drug screen An assessment for phobic disorder Question 41 The difference between a manic and hypomanic episode is best characterized by all the following except: The duration of symptoms is shorter for hypomanic episodes Hypomanic episodes do not cause marked impairment in function There are no psychotic features with hypomanic episodes Hypomanic episodes may occur as a response to antidepressants Question 42 Pharmacotherapy Psychoanalytic psychotherapy Transference-focused psychotherapy A stress interview Question 43 Urinary tract infection Mild cognitive impairment Normal pressure hydrocephalus Depression Question 44 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 depressed, and appears flat. This includes all the following elements of physical examination except: Appearance Motor activity Mood Affect Question 45 Low-grade chronicity for at least 2 years Insidious onset, usually in childhood or adolescence Strong family history of depression and bipolar disorder Long asymptomatic periods between episodes Question 46 Which of the following personality disorders is associated with females with fragile X syndrome? Borderline Narcissistic Dependent Schizotypal Question 47 Borderline personality disorder Structural brain damage Substance abuse disorder Question 48 Family therapy Behavior therapy Psychoanalytic therapy Interpersonal therapy Question 49 He needs to be increased to 200 mg today and follow up in 4 weeks He should maintain this dose for 4 weeks and reassess He should change his therapy to an SNRI Addition of cognitive behavioral therapy would likely improve response Question 50 Pharmacologic treatment is not indicated The etiology is different Perfectionism is common Physical symptoms are lacking Question 51 Intrusion symptoms Avoiding stimuli Autonomic arousal Clinical significance Question 52 At least 90 minutes Person-centered Comprehensive Insight-oriented Question 53 Patients who require long-term benzodiazepine management should be maintained on long-acting agents The use of benzodiazepines long term for anxiety does not pose a high risk of dependence and abuse The panel supports increased federal and/or state restrictions on benzodiazepine prescribing When detoxifying from therapeutic dosages, daily intake should be decreased by 10–25% Question 54 The time course of symptoms Presence of physiologic arousal Reexperiencing the event Response to pharmacotherapy Question 55 Urine drug screen Hepatic function test Pulmonary function test 12-lead ECG Question 56 Reinforcement Reassurance Encouragement Acknowledgement Question 57 Macrocytosis Transaminitis Uremia Hypertriglyceridemia Question 58 Fluoxetine Paroxetine Escitalopram Sertraline Question 59 Alcohol Cannabis Opiate Hallucinogen Question 60 Caffeine intake Use of dietary supplements Testosterone level Liver function tests Question 61 From a biological perspective, all of the following neurotransmitters are implicit in the anxiety response except: Gamma-aminobutyric acid Norepinephrine Serotonin Dopamine Question 62 BPRS Toxicology screen Head imaging Family history Question 63 Schizophrenia Social anxiety Schizoid personality Agoraphobia Question 64 Any history of suicidal attempts or serious ideation History and current patterns of substance abuse Concomitant psychotic features such as hallucination or delusion Manic symptoms that are sustained most of the day for at least 2 weeks Question 65 Lithium carbonate is the drug of choice for Joe Joe would be best managed with injectable antipsychotics Risperidone is an appropriate choice when mania is characterized by anger and violence Symbyax (olanzapine/fluoxetine) is the safest choice for Joe given his psychosis Question 66 Reveal a very strong desire for an intimate relationship Become very engaged in group therapy Describe an active fantasy life with imaginary friends Demonstrate psychotic or delusional features Question 73 The major defensive mechanisms employed by patients with histrionic personality disorder include: Repression and dissociation Projective identification Fantasy and isolation Splitting Question 74 Lorazepam Venlafaxine Propranolol Buspirone Question 67 Patients on lithium carbonate for management of bipolar disorder should be subject to routine assessment of: CBC and BMP TSH and serum Na+ CMP and ECG LFTs and EEG Question 68 Depression presents with more somatic symptoms as compared to younger age groups Ageism may cause primary care clinicians to accept depressive symptoms in the elderly as normal Risk factors include loss of spouse, physical illness, and social isolation Incidence of geriatric depression is estimated at 60–75% of the population Question 69 When differentiating a major depressive episode from dysthymic disorder, the PMHNP considers that: The cognitive theory of depression does not apply to dysthymia Hospitalization is typically indicated early in the course of dysthymia Dysthymia is more subjective in its presentation than depression Insight-oriented therapy is the most effective treatment for dysthymia Question 70 Reconsider the diagnosis of major depressive episode Add bupropion to her medication regimen Increase the dose of fluoxetine Change to another antidepressant medication Question 71 Internal consistency reliability Parallel form reliability Construct validity Face validity Question 72 The presence of fixed delusional thought Disdain for weak or sickly people A history of antisocial behavior Extreme ―drama‖ in most personal relationships Question 75 Pharmacotherapy with clonazepam Free-association, nondirective therapy Interpersonal therapy Serotonergic agents [Show Less]
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NURS 6670 MID-TERM EXAM-QUESTIONS AND ANSWERS
NURS 6670 MID-TERM EXAM-QUESTIONS AND ANSWERS NURS 6670 MID-TERM EXAM-QUESTIONS AND ANSWERS (VERIFIED). Latest. Question 1 Alexa is a 27-year-old femal... [Show More] e who has come to group therapy while she is in the city jail. She was arrested 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 sentenced 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 fired 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 extended for 30 days because she got into a fight with another inmate and beat her up so badly she had to be admitted to the hospital for 6 days. The PMHNP considers which of the following personality disorders? a) Histrionic b) Narcissistic c) Borderline d) Schizoid Question 2 Anne is a 32-year-old female who presented 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 admitted 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: a) The physiologic symptoms of withdrawal may require a short-term hospitalization b) Unlike other substances of abuse, there are no medications to help reduce the intensity of withdrawal c) She will need to be monitored for depression d) Overcoming the intense craving for cocaine is the biggest issue Question 3 Clare’s history of personal relationships is characterized 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 livein 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: a) Has disproportionate anger toward an abusive spouse Question 4 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 be centered upon the patient’s: b) Clothing c) Speech pattern d) Anger e) Anxiety Question 5 A PMHNP student is reviewing his notes from his clinical experience over the past week to prepare his first required 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? a) A 27-year-old female with a 1-month history of social withdrawal, anorexia, hypersomnia, unprovoked outbursts of anger, and a strong family history of endogenous depression. b) A 41-year-old male with a history of childhood sexual abuse, loss of interest in both his professional and personal life, an unplanned 10 lb. weight loss in the last 3 months, and perceptual disturbances. c) A 65-year-old male whose wife died 2 months ago and he reports a 3-week history of generally depressed mood, guilt about his wife’s death, insomnia, difficulty focusing on daily tasks, with increasing thoughts of dying. d) A 72-year-old female who just relocated across country to live with her adult son and daughter-in-law who is despondent about leaving her home and reports forgetfulness, loss of appetite, new onset bowel problems, and extreme loss of energy. Question 6 A variety of pharmacologic agents have demonstrated effectiveness in the treatment of post-traumatic stress disorder. Which of the following does not have any evidenced-based support in the literature? a) SSRIs b) TCAs c) Antiadrenergic d) Antipsychotics Question 7 The PMHNP is on call at the local county correctional facility. He is asked to evaluate M.S., a 21-year-old male who was just arrested 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 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 happened 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: a) Stuttered b) Increased c) Childlike d) Confused Question 8 Fletcher is a 29-year-old male referred for court-ordered counseling. He has a long history of repeated 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 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-adjusted. 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 started drinking heavily; it was ―all downhill from there.‖ The PMHNP considers that: a) History and symptoms are most consistent with antisocial personality disorder b) Fletcher needs a neurological workup to include an EEG and assessment for neurological soft signs c) Consistent with his symptoms, Fletcher will likely respond well to a stress interview d) It is likely that substance abuse is the underlying cause of symptoms and should be explored further Question 9 Which among the following neurotransmitters is decreased in depression and increased in mania? a) Dopamine b) Norepinephrine c) Serotonin d) Glutamate Question 10 Among the various types of therapeutic intervention for patients with borderline personality disorder, which of the following is characterized 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? a) Mentalization-based treatment (MBT) b) Transference-focused psychotherapy (TFP) c) Countertransference-focused psychotherapy (CTFP) d) Dialectical behavioral therapy (DBT) Question 11 Mr. Kendall is a 47-year old male who is presented to care by his younger sister, Megan. Mr. Kendall has spent his entire adult life living in an apartment that was attached 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 considered odd all his life, has never married or even dated as far as Megan knows, but she had no idea how odd he was. When his mother died, he seemed disconnected 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? a) A history of schizophrenia of a first-degree relative b) Sustained psychosis predating his mother’s death c) Comorbid Asperger’s syndrome d) Apparent frank thought disorder Question 12 Which of the following is a true statement with respect to the treatment of narcissistic personality disorder? a) Psychoanalytic psychotherapy has strong empiric support b) Both serotonergic drugs and lithium are useful c) Group therapy is rarely helpful d) Immobilized patients (hospitalized or incarcerated) have the best outcomes Question 13 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 described as a life-long ―loner.‖ In high school and college, he kept to himself, excelling in his studies in the sciences. Currently described 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: a) Schizoid personality disorder b) Schizotypal personality disorder c) Paranoid personality disorder d) Delusional disorder Question 14 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: a) A history of racing thoughts b) Difficulty interacting with others c) Extremely high expectations of self d) Significant impairment at work 7 Question 15 Hugo is a 39-year-old male who has encouraged his wife to come to counseling because he is worried 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 worried 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 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: a) Hugo’s wife meets diagnostic criteria for this disorder b) A trial period with no wine ingestion is necessary to assess for withdrawal symptoms c) The family history should be assessed for genetic tendency d) Hugo may have unreasonable expectations Question 16 When developing a pharmacologic treatment plan for the management of major depressive disorder, the PMHNP counsels the patient that the medication will be titrated up to the appropriate dose and then continued for a minimum of 3 months; medication must not be stopped abruptly or without provider supervision. This is because the physiologic consequence of abrupt cessation is likely to result in: a) Antidepressant discontinuation syndrome b) Rebound depressive symptoms c) A manic or hypomanic episode d) Unresponsiveness to medication with future episodes Question 17 Which of the following is a true statement with regard to the etiology of substance abuse? a) Neurotransmitters or receptors have been identified with most substances of abuse except for alcohol b) Twin and sibling studies do not support a genetic component with respect to the etiology of substance abuse c) Substances of abuse decrease activity in the amygdala and anterior cingulate d) The WHO schematic of drug use and dependence identifies immediate antecedents as the central element of abuse Question 18 Assessment of the manic state in a patient with bipolar disorder is likely to include all the following except: a) Mood-congruent delusions of grandeur b) Suicidal or homicidal ideation c) Impaired judgment with no insight d) Unrestrained flow of ideas Question 19 When performing a psychiatric assessment of an elderly patient with Alzheimer’s dementia, the PMHNP recognizes that: a) An important part of the history will come from the caregiver b) The patient must also be interviewed alone to preserve privacy of the relationship c) A sexual history is not necessary in patients who are not sexually active d) All of the above. Question 20 Jeffrey T. is a 27-year-old man who has presented for care after being required 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 intoxicated. He is a bit resentful at being required to attend therapy; he is very vocal that his driving was not impaired 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: a) Dependence b) Abuse c) Adaptation d) Addiction Question 21 Danielle is a 31-year-old female who is having a psychiatric evaluation at the insistence of her husband. They have been married for 4 years, and her husband has finally become so frustrated 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: a) Diazepam b) Pimozide c) Psychotherapy d) Group therapy Question 22 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 stopped 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 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 affected her physical health at all. While counseling Margo about alcohol withdrawal delirium (delirium tremens), the PMHNP advises Margo that: a) She should be admitted for inpatient detoxification b) People in good physical health rarely have DTs c) A beta adrenergic antagonist medication can minimize her risk of DTs d) Women rarely experience DTs Question 23 Anthony is a 41-year-old male patient who presents for evaluation. His wife made the appointment because she is worried 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 evaluated by his primary care provider and has no apparent medical conditions. His wife reports that he has been diagnosed with depression in the past, and has even taken medication that seemed to help. This time he just refused 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: a) Venlafaxine and clozapine b) Fluoxetine and olanzapine c) Amitriptyline and haloperidol d) Paroxetine and buspirone Question 24 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 committed to the marriage and loves her husband, but finds his inflated 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 embarrassed by that. While counseling Marlene, the PMHNP advises her that patients with narcissistic personality disorder have extremely fragile: a) Sense of self-importance b) Defense mechanisms c) Self-esteem d) Interpersonal relationships Question 25 Marie is a 30-year-old woman who presents for follow-up after starting treatment for bipolar disorder. She had been treated on and off for depression for years and had a history of alcohol abuse. After her marriage, she decided 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 started on a mood stabilizer 1 month ago. She tolerated 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: a) Discontinuing medication presents a marked risk of return to alcohol b) A program of psychotherapy should be started before stopping medication c) She needs to continue medication for a minimum of 3 months d) Cessation of mood stabilizers prematurely increases risk for a depressive episode Question 26 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 considered the standard for assessing clinical outcomes in treatment studies of schizophrenia? a) SCID b) BPRS c) PANSS d) HAM-D Question 27 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? a) Eye movement desensitization and reprocessing therapy b) Implosive therapy c) Systematic desensitization d) Relaxation and cognitive techniques Question 28 A 22-year-old male patient is started on sertraline 50 mg p.o. daily after presenting with a major depressive episode. After tolerating without difficulty for 2 weeks, his dose is increased 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: a) When symptoms are preceded by antidepressant therapy, a diagnosis of bipolar does not apply b) His symptoms may be consistent with bipolar disorder if they persist for at least 2 weeks c) A formal assessment of the social and occupational implications of his symptoms should be performed d) The symptoms are most likely a physiologic adaptation to the sertraline and most often normalize Question 29 The PMHNP is seeing a patient who has been referred by primary care. The patient was diagnosed with major depressive disorder and trialed 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 detailed 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: a) Lamotrigine b) Valproic acid c) Lithium d) Amitriptyline Question 30 Mariel is a middle-aged woman who is referred 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 moved away from home she will need to be more independent and is very committed to trying to manage her fear. The PMHNP counsels Mariel that the most successful therapy for phobic disorders is: a) Insight-oriented psychotherapy b) Behavior therapy c) Virtual therapy d) Pharmacotherapy Question 31 Cannabis intoxication delirium is characterized by all of the following except: a) Impaired memory b) Perception c) Psychosis d) Motor coordination Question 32 Tim is a 20-year-old male who has been referred for care by his college counselor. The counselor has noted 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: a) Avoidant personalities have a strong desire for personal relationships b) Avoidant personalities may have an active fantasy life c) Schizoid personalities are perceived as distant and aloof d) Schizoid personalities may be very attached to animals Question 33 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 worked 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 asked why he thinks he will be homeless, he responds by talking about how many hours he has worked 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: a) Affect b) Cognition c) Thought process d) Abstract reasoning Question 34 Cory is a 23-year-old male recently incarcerated 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 required 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: a) Have a family history of the same disorder b) Respond well to dialectical behavioral therapy c) Have impaired emotional defense mechanisms d) Come from smaller nuclear families Question 35 [Show Less]
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NURS 6670 FINAL EXAM STUDY GUIDE CHAPTER 1 TO 39
NURS 6670 FINAL EXAM STUDY GUIDE CHAPTER 1 TO 39 NURS 6670 FINAL EXAM STUDY GUIDE CHAPTER 1 TO 39 Case Study, Mohr: CHAPTER 1, Introduction to Psychiat... [Show More] ric–Mental Health Nursing 1. Karen is a 25-year-old white woman who lives alone in an apartment with her dog. Karen has been divorced for 2 years and is taking Prozac prescribed by her psychiatrist for depression. Karen and her boyfriend had been discussing marriage until he told her that he wanted to end their relationship. Karen became even more depressed and could not work for a week. Karen returned to work, refusing to discuss her issues with family, friends, or coworkers. She did, however, make an appointment to see a psychiatric nurse practitioner. Karen told the nurse that she was making some changes in her life. Karen said that she and a girlfriend were joining a gym program for workouts and a social group for young men and women. Karen stated that she realizes that her former boyfriend had not been committed to her, and she anticipates meeting and dating other young men from the adult social group. Karen also said that she thinks that the gym exercise will be beneficial to her mentally and physically. Learning Objectives: 1, 4) a. How will the psychiatric nurse assess if Karen has made progress toward self-realization? Karen had suffered from depression which is a form of mental disorder as a result of divorce and a broken relationship with her boyfriend. This situation according to Hypocriticus in 15th century BC, upholds the brain as the organ of consciousness; this occurs when both normal and abnormal behavior arise from the brain. The psychiatric nurse can assess if Karen has made progress towards self-realization by committing to diagnosing and treating her responses to the problems that caused her psychiatric disorder. In-addition, the nurse can make assessment based on Karen’s psychoanalytical disposition such as: trasferrence, defense mechanism, countertransference, acting out, denial of the reality befallen her and projection. b. Identify strengths that Karen has for progress in personal growth. The strengths Karen has for progress in personal growth include the followings: • Ability to make use of social support, that is, she visited a psychiatric nurse, social group and registered in a gym. • She was realistic about her situation, therefore made herself ready to face the reality before her. • Karen sought immediate medical attention where she was administered with Prozac to help mitigate her depression state. • Her cognitive behavioral responses showed optimism towards a better life as well as fighting against her depressed state. Hence, her willingness to date younger men. c. Karen has been seeking treatment for her depression. Analyze the factors that might contribute to Karen’s reluctance to discuss her depression with others. Karen’s reluctance to discuss her depression with others hinges on the fact that her depression was a kind called social depression. Social depression is a psychological disorder caused by several factors such as: interpersonal relationship which involves the relationship between a person and the interactions of emotions of each individual expressed directly and discreetly to each other. Another is a Common interpersonal relationship, this includes: Family, social environment (work place), and interaction among age groups and genders. Because Karen had divorce and broken relationship, she didn’t feel safe in herself discussing her depression with family and friends but to seek a professional whose job is to attend to her depressed case. Hence, her neuroticism was calm and strong willed. Case Study, Mohr: CHAPTER 2, Neuroscience: Biology and Behavior 1. Michael is a 22-year-old college senior whose GPA has declined with this semester’s grades. Michael plans to apply to medical school and thinks that the lower GPA may prevent his acceptance to medical school. For the last 2 weeks, Michael has skipped most classes because he has insomnia and fatigue. Michael is now very depressed and has been thinking of suicide. He took a loaded gun from his father’s gun cabinet and then wrote a suicide note to his family. At the last moment, he telephoned 911 and told them of his suicide plan. The police came, took the gun away, and then took Michael to the city hospital to be admitted for psychiatric treatment. In the admission interview with the psychiatric nurse, Michael said that his pastor thought that only weak-willed people experienced depression and that it was a punishment for personal sins and the sins of one’s ancestors. Michael told the nurse that he must be weak-willed and will never be able to accomplish anything. The psychiatric nurse explained that multiple factors are the cause of depression. The nurse told Michael that one theory holds that an imbalance of neurotransmitters, or chemical messengers of the brain, occurs in depression. Neurotransmitters influence the individual’s emotions, thoughts, and subsequent behavior. Recent research implies that neurobiology, heredity, as well as Psychological and environmental factors may be involved in the development and progression of depression. (Learning Objectives: 5, 6) a. Will Michael think that the psychiatric nurse’s explanation for the cause of depression is more correct than that of his pastor? No. It is indeed difficult for Michael to accept the doctor’s opinion since before he fell sick, he had information from the pastor on depression on which he solely believed and now he is a living prove. b. Michael asks the nurse why he has to have psychotherapy. He states that he only needs to take a couple of pills to get better. How should the nurse respond to Michael’s question and comment? The nurse has to explain to Michael why he should consider psychotherapy. Because of the many misconceptions about psychotherapy, you may be reluctant to try it out. Even if you know the realities instead of the myths, you may feel nervous about trying it yourself. Overcoming that nervousness is worth it. That’s because any time your quality of life isn’t what you want it to be, psychotherapy can help. Taking only pills will not help but increase the effects because most of these medication have side effects which would have been avoided by psychotherapy. c. Develop an assessment question for each of the following possible causes of Michael’s development of depression: Genetic, Environment and Stress. From the Geriatric Depression Scale: “Do you prefer to stay at home rather than going out and doing new things?” This question asks for a yes or no answer and recognizes that isolation and withdrawal are common signs of depression — especially in the elderly. From the MADRS: “How is your sleep?” Answers include: Sleeping as usual, slight difficulty, sleep reduced by at least two hours, or getting less than three hours of sleep at night. Greater sleep disturbance signals a greater risk for depression. From the Beck Depression Inventory: “How is your energy?” Declines in energy level are a common sign of depression — the more significant your lack of energy, the higher your depression risk rating. Possible answers to this question include: As much energy as ever, less energy than before, not enough to do much, or not enough to do anything Case Study, Mohr: CHAPTER 3, Conceptual Frameworks and Theories. 1. The student nurse has been assigned a 37-year-old woman admitted to the psychiatric hospital with an anxiety disorder. This morning, the student notices that the client has a tense facial expression and is walking constantly around the group room. The student walked over to the client and used reflective communication by stating, “I see that you have a tense expression and are walking around almost all of the time. Is there something that we could discuss?” The client replied that she has talked on the telephone to her mother who was keeping her children while she was in the hospital. The client said that her mother had told her that she was not a good mother, and then said, “I guess I am a bad mother, but I could never measure up to my mother’s expectations.” The student has learned that negative self-talk can greatly aggravate anxiety and lead to depression. The student decided to use a behavioral intervention with the client and asked the client who is a good artist and why the client liked the artist’s works. The student and the client then made a list of activities that the client liked. The student taught the client to engage in one of these activities when an unpleasant experience evoked negative thoughts. The following day, the student decided that the client needed some cognitive restructuring for her relationship with her mother. The student taught the client that during discussions with her mother, feelings of incompetence might be experienced when the mother made negative comments. The client was instructed that if her mother made negative comments about parenting, she was to immediately tell her mother that she was a good parent to her children and terminate the conversation at the first opportunity. (Learning Objective: 3) a. Will the client be able to learn cognitive restructuring in her relationship with her mother? Yes, she will learn because by keeping positive thought, her cognitive restructure will develop to the positive. Based on the above facts and behavioral intervention made between client and the student nurse it is possible to established a good and collaborative relationship with her mother. Besides, client can also be able to gain of cognition to maintain a fruitful relationship with her mother. Anxiety is a normal reaction to certain situations. A small level of anxiety is normal, but severe anxiety can be a serious problem. Academic anxiety can become more detrimental over time than community based anxiety. Much evidence supports the notion that social anxiety causes impairment in many domains of life, such as romantic relationships, friendships, work, and physical health. b. How will engaging in activities help the client with her anxiety? Based on the everyday behavior of client the patient nurse decided a plan that how to solve this problem. Then the student nurse asks client what happened? From this nurse learn that some phone call received from home relative to negative thought. The student has learned that negative self-talk can greatly aggravate anxiety and lead to depression. That is why nurse decided some plan and asked to each client who are great artist their favorite items or activities. Then, according to that nurse can able to engage the client into her favorite hobbies, when an unpleasant experience evoked negative thoughts. The next day, the student decided that the client has been gaining some cognitive restructuring for her relationship with her mother. Finally, the student nurse had advice to the client that in future when her mother made some negative thought or narration regarding parenting she should immediately and confidently tell her mother that she was a good parent to her children and closed this conversation immediately and if possible divert the topic to some extent. So, that mental thought can be diversified to some extent could be able to help to prevent anxiety. Case Study, Mohr: CHAPTER 4, Evidence-Based Practice 1. Jessica, a 17-year-old girl who came with her family from Romania to the United States 10 years ago, is brought to the mental health clinic by her mother. At the admission psychiatric interview, the mother stated that Jessica has been saying for 6 months that aliens have been conducting experiments on her and will soon take her in a spaceship to their planet. Jessica is often awake at night and roams the house with a hammer and sharp knife, searching for aliens. Jessica’s mother says that she fears that some night Jessica will harm a family member whom she believes to be an alien. The mother then said that she did not bring Jessica for psychiatric care earlier because she had heard that much of mental health treatment was quackery and a waste of money. The psychiatric nurse explains to Jessica’s mother that all mental health treatment is based on scientific principles. (Learning Objective: 3) a. How would the nurse best explain that the care Jessica will receive at the psychiatric facility is based on evidence? Give two examples of psychiatric evidence-based care, and explain the scientific evidence that supports your examples. The nurse will have to explain to Jessica the evidence that psychosis can be treated. She can will give examples of cases like hers’ which has been treated and get out of situation. The effort to hold practitioners to evidence-based directives is widespread. Roughly two-thirds of Americans with private health insurance are enrolled in managed behavioral health care organizations (MBHOs), and these have used efficacy research to limit types and duration of care. In the public sector, the District of Columbia Department of Mental Health (DMH) has proposed a policy regarding evidence-based psychotherapy in that system. According to the draft policy, all psychotherapy services delivered to community-based adult consumers will conform to a short list of EBPs. Case Study, Mohr: CHAPTER 5, Legal and Ethical Aspects. 1. Gerald, a 22-year-old black man, has a diagnosis of schizoaffective disorder. Gerald has been living at home, but this afternoon he had a physical fight with the neighbors and set a fire in their garage to burn their house. His father took him to the local psychiatric hospital and said that he wants an involuntary commitment for Gerald since he will not agree to the hospitalization. The father expressed concern over Gerald’s legal rights. The psychiatric nurse practitioner recommends to the father that he commit Gerald on involuntarily for emergency care for a period of 72 hours since he is clearly a danger to others. The nurse explains that Gerald will be evaluated to determine if he needs involuntary detention for observation and treatment for a longer period of time. The nurse explains that Gerald will be periodically evaluated, and that when it is determined that he is no longer a danger to others or himself, Gerald will be released from the hospital. (Learning Objectives: 4, 5) a. What basic legal rights does Gerald have at the time of this illness? • Basic legal rights • Right to humane and dignified treatment, and must be treated in accordance with a specialized treatment plan, including a discharge plan • Right to receive a physical exam within five days of being hospitalized and at least annually thereafter. • Right to examined by a psychiatrist within 48 hours of being hospitalized and at least every six months thereafter • Right to appropriate personal clothing • Right to safe and sanitary environment • Right to balance and nutritious diet b. Why can Gerald not make the decision for himself about being an involuntary emergency commitment to the hospital? Gerald cannot make the decision for himself about being an involuntary emergency commitment to the hospital because he lacks insight about his illness at the time of admission hence he cannot accept to be admitted. Moreover, he is a threat to himself and others and thus he should be admitted even without his consent Case Study, Mohr: CHAPTER 6, Culture 1. Mrs. Maria Gonzalez is a Mexican National, age 58, who was brought to a health clinic by her adult son. She is complaining that she has had aches and pains all over her body for 2 days. Mrs. Gonzalez states that her neighbor is a witch who gave her the mal do ojo (evil eye) and cast a spell on her to cause her death. The clinic nurse takes an oral temperature and it is 101º F. The clinic nurse refers Mrs. Gonzales to the clinic physician because she believes that the client has influenza. Mrs. Gonzales is reluctant to see the doctor and states that the doctor cannot prevent her death. (Learning Objective: 8) a. How can the nurse provide culturally competent care to Mrs. Gonzalez and convince her to see the clinic doctor? People have different health seeking behaviors. Culture plays a very significant role in determining someone health seeking behavior. in this case, the nurse must understand Gonzalez culture, be in his shoes then try to convince him to see a doctor. The nurse can achieve this by looking for someone who can communicate better with Gonzalez and slowly convince him that he is suffering from an infection b. Can Mrs. Gonzalez be convinced that there is no spell cast on her to cause her death? Explain your answer. Yes, though it will take time. Getting a family member or a relative to talk to Gonzalez and convince him can work. Alternatively, getting someone from Gonzalez culture and explain to him that he had the same problem before and it was discovered that it was an infection and not evil eye will really help Case Study, Mohr: CHAPTER 7, Spirituality in Psychiatric Care 1. Marta, a 16-year-old high school teenager, has been depressed over a recent break-up with her boyfriend. Marta, accompanied by her mother, is seen in the community mental health clinic. A mild antidepressant is prescribed for Marta with weekly counseling sessions. Marta and her mother ask if it would be beneficial for Marta to attend a 1-week church camp to begin in 2 months. Marta would like to reconnect with her religion and voices a belief that the camp experience will help her. The psychiatric nurse practitioner informs them that research reveals that involvement in religious activities has been helpful in social support and in coping with depression. Marta appears relieved and said that she will register for the church camp. (Learning Objective: 2) a. Why might Marta want to reconnect with her religion, and how will attendance at the church camp benefit Marta? • Marta would want to reconnect with her religion because when she had a boyfriend, she might have gone away from church because of commitment to their relationship thus forgetting about her religion. • The attendance of the church camp will help her forget about the break-up and gain moral values during the camp. b. If Marta attends the church camp, will this pose a problem to counseling sessions? No. In fact it will be of help to her because she might get some teaching during the camp and the prescription will just be like an addition. Case Study, Mohr: CHAPTER 8, Nursing Values, Attitudes, and Self-Awareness 1. Joe, a 26-year-old Caucasian man, is a client in a state prison system. Joe is admitted to the prison clinic after being involved in a fight in which he sustained a stab wound to the chest that did not penetrate the lungs or major blood vessels. The clinic doctor on duty was an employee of several years at the prison. The doctor showed little compassion for Joe, stating, “He is a convicted criminal, and he is just getting back some of what he deserves.” The new graduate nurse who was being oriented to the clinic thought that the doctor did not exhibit professional behavior toward Joe. The clinic nursing supervisor later explained that the doctor was influenced by situational factors. (Learning Objective: 3) a.What is a situational factor, and how can this influence the behavior of healthcare workers? Provide an example where a situational factor impacted on your behavior while in a healthcare setting. Situational factor is an external factor that influences one's perception towards something or somebody, like in this case, the doctor perceived the prisoner as a criminal and such perception affected the services he rendered to the prisoner. During practice, as health practitioners we may perceive certain groups of people such as gays in a different way which may affect the quality of services we give some practitioners perceive gays as immoral and often give them poor servi [Show Less]
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