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
... [Show More] 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 [Show Less]