NURS 6670 PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER ROLE II: ADULTS AND OLDER ADULTS MIDTERM EXAM

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 wont help her. Alexas friend Melanie is the absolute best person in the world, but she cant 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 into a fight with another inmate and beat her up so badly she had to admitted to the hospital for 6 days. The PMHNP considers which of the following personality disorders? 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 23 times, other days more. She also uses it occasionally at home and most weekends. During her third session, she that it is a financial burden, and she basically cannot afford any other form of recreation. She understands that if she uses again she will lose her job, and she admits that she loves her job and that cocaine is not worth losing it. When counseling her about cessation strategies, the PMHNP advises all the following except: Question 3: Clares history of personal relationships is by complete intolerance of alone. Whether it is an intimate-partner relationship or a close friend, Clare appears to always need someone in her life. She had a live-in boyfriend of 3 years, and while they were together, he took care of everything. The PMHNP expects all of the following to additional features of Clares history except: 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 centered upon the patients: Question 5: A PMHNP student is reviewing his notes from his clinical experience over the past week to prepare his first case presentation on a patient suffering a major depressive episode. Which of the following patients best represents the DSM-5 criteria for major depressive episode? Question 6: A variety of pharmacologic agents have effectiveness in the treatment of post-traumatic stress disorder. Which of the following does not have any evidenced-based support in the literature? Question 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 following an altercation at a local bar. M.S. has never been before and apparently has no psychiatric or medical history available. His toxicology screen was negative for alcohol or any drugs of abuse.His mother says that he has in the past had some occasions when he got kind of agitated, but this is the first time its been a problem. Reportedly some people from his office were at the bar celebrating a birthday, and before anyone knew what happened an argument into M.S. getting very loud, yelling, and acting _crazy_ before he a coworker and started breaking bottles. When considering a manic or hypomanic episode, the PMHNP expects that his speech would most likely : Question 8: Fletcher is a 29-year-old male referred for court-ordered counseling. He has a long history of offenses including DUI, domestic violence, battery, and other violent acts that fortunately have not yet any serious injury or death to the recipients. An interview with his wife reveals that he has about almost everything for the last few years; he is able to get for jobs because he is very engaging and like able, and then invariably he gets fired because he misses work and doesnt do his job properly when he is there. According to the wife, they have known each other since high school, where Fletcher was very happy and well . He was on the soccer team, by teachers, and never demonstrated the tendencies he does now. Apparently in college he got with a fraternity that was notorious for alcohol and drug abuse, and he started drinking heavily; it was _all downhill from there._ The PMHNP considers that: Question 9: Which among the following neurotransmitters is in depression and in mania? Question: 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? Question 10: Kendall is a 47-year old male who is to care by his younger sister, Megan. Mr. Kendall has spent his entire adult life living in an apartment that was 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 . He has apparently been odd all his life, has never or even dated as far as Megan knows, but she had no idea how odd he was. When his mother died, he disconnected from reality and had episodes of talking to people who werent 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 doesnt need to move because he knows the house will not sold. When considering a diagnosis of schizotypal disorder, the PMHNP expects which of the following to present in the history? Question: Which of the following is a true statement with respect to the treatment of narcissistic personality disorder? Question: While preparing a class on personality disorders for a class of PMHNP students, the instructor is presenting case studies of patients with cluster A personalities. One of these cases is Clark M., a 41-year-old man who is as a life-long __ In high school and college, he kept to himself, excelling in his studies in the sciences.Currently as a brilliant computer programmer, he clearly prefers solitary pursuits and the company of his cat over people. He knows he is socially isolated, but he is just more comfortable this way. This description is most consistent with: Question: Darius is a 26-year-old male who presents for care as part of couple therapy with his wife, who is being for dependency Darius himself seems very anxious to _do the right thing_ and appears to want to please the therapist. During the evaluation, Darius is impeccably , very formal in his presentation and interaction, and is watchful of time because he has an appointment after the interview and states several times that he cannot late. The PMHNP considers that Darius may have obsessive compulsive personality disorder (OCPD). In differentiating this from obsessive compulsive disorder (OCD), she explores his history further for: Question: Hugo is a 39-year-old male who has his wife to come to counseling because he is about her wine drinking. Hugo says that he and his wife have shared a bottle of wine with dinner most nights for the last couple of years, but in the last few months he has become that she drinks too much. They both agree that she never really becomes , but he does not like the fact that evening wine has become the most important part of her meal. If he wants to go out, she will only go to a place that has a wine she likes. Last month they went on a week-long vacation, and she on packing enough of her wine to last the whole time. If they go to a restaurant that does not have a wine she likes, she will take her own in a disposable coffee cup. It seems like for the last few months, she has been drinking more and more, occasionally finishing the bottle alone when he doesnt want any. Both partners agree that there is no interference with work or any activities or responsibilities, but it is causing some tension in their marriage. When considering a diagnosis of substance use disorder, the PMHNP considers that: Question: When developing a pharmacologic treatment plan for the management of major depressive disorder, the PMHNP counsels the patient that the medication will titrated up to the appropriate dose and then for a minimum of 3 months; medication must not stopped abruptly or without provider supervision. This is because the physiologic consequence of abrupt cessation is likely to result in: Question: Which of the following is a true statement with regard to the etiology of substance abuse? Question: Assessment of the manic state in a patient with bipolar disorder is likely to include all the following except: Question: When performing a psychiatric assessment of an elderly patient with Alzheimers dementia, the PMHNP recognizes that: Question: Jeffrey T. is a 27-year-old man who has presented for care after being to do so by the county court. He was in a car accident, and while he was not at fault for the accident, routine blood alcohol screening revealed that he was driving while intoxicated. He is a bit resentful at being to attend therapy; he is very vocal that his driving was not and that he is able to function normally even after drinking what others might consider excess amounts of alcohol. His wife confirms this; they both admit that what began as one or two beers after work a few years ago has evolved to where he now drinks at least a 12 pack of beer nightly. Regardless, they both confirm that he never _seems drunk,_ and this does not interfere with his job or fulfilling his family functions. Jeffreys ability to function normally despite high blood alcohol is likely a result of: Question: Danielle is a 31-year-old female who is having a psychiatric evaluation at the insistence of her husband. They have been for 4 years, and her husband has finally become so frustrated by her jealous behavior that hethreatened to leave her if she didnt _get help._ Her husband insists that he has never 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 friendsher sister is her closest social contact, but Danielle has angry with her for several weeks and wont 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 doesnt understand why she is therethere is not a problem. The PMHNP considers the most likely diagnosis and discusses with Danielle that the treatment of choice is: Question: Margo is a 47-year-old female who admits to a history of fairly heavy alcohol use over many years. She admits that she has had periods in the past where she drinking for a brief time, but she has always back to At this point she says she has been drinking a fifth of bourbon every 23 days for over a year. She has a new boyfriend and really wants to stop drinking, but she is afraid she will _go into the DTs._ She has been reading about it on the Internet, and she knows it can fatal. Other than her drinking, Margo is amazingly healthy. She had a complete physical exam with blood work through her primary doctor, and he says that her drinking does not appear to have affected her physical health at all. While counseling Margo about alcohol withdrawal delirium (delirium tremens), the PMHNP advises Margo that: Question: Anthony is a 41-year-old male patient who presents for evaluation. His wife made the appointment because she is about him and he would not seek care on his own. Anthony has become progressively over the last few months and is in danger of losing his job because he misses so many days. He has been by his primary care provider and has no apparent medical conditions. His wife reports that he has been with depression in the past, and has even medication that to help. This time he just to pursue care. After a comprehensive assessment, the PMHNP diagnoses the patient with major depressive episode with psychotic features. Consistent with the Texas Algorithm Medication Project (TAMP), the appropriate choice of initial medication therapy would : Question: 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 sense of self-importance and complete lack of empathy to especially difficult. She believes he has a good side, but most of her friends have only ever seen extreme arrogance, and she is by that.While counseling Marlene, the PMHNP advises her that patients with narcissistic personality disorder have extremely fragile: Question: Marie is a 30-year-old woman who presents for follow-up after starting treatment for bipolar disorder. She had been on and off for depression for years and had a history of alcohol After her marriage, she to stop drinking and was successful in eliminating alcohol from her life; unfortunately, she then went on to have a manic episode and was finally on a mood stabilizer 1 month ago. She medication very well, and within 2 weeks symptoms were much improved. Now, 4 weeks later, she feels much better and wants to come off medication. The PMHNP tells her that: Question: and reliable instruments are an important part of assessment for both clinical practice and research in psychiatrics. Which of the following tools is currently the standard for assessing clinical outcomes in treatment studies of schizophrenia? Question: Among the various psychotherapeutic techniques available for treating post-traumatic stress disorder, which mechanism achieves its effect by having patients work through the traumatic event while in a deep state of relaxation? Question: A 22-year-old male patient is on sertraline 50 mg p.o. daily after presenting with a major depressive episode.After tolerating without difficulty for 2 weeks, his dose is to 100 mg p.o. daily. Approximately 4 weeks later he reports an unusual set of new symptoms for the last week and a half. He says he feels _ up_ and just very generally and nervous. He was short at work and home and was snapping at people for no good reason. He also reports difficulty concentrating at work. Last week he disproportionate anger at his work and his boss him that he was bipolar and should put on medication. The PMHNP discusses with the patient that: Question: The PMHNP is seeing a patient who has been by primary care. The patient was with major depressive disorder and 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 psychiatric history is significant for indicators of bipolar disease, as well as a family history of bipolar disease in both the patients father and paternal aunt. This patient will most likely benefit from: Question: 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 away from home she will need to 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: Question: Cannabis intoxication delirium is characterized by all of the following except: Question: Tim is a 20-year-old male who has been for care by his college counselor. The counselor has that Tim engages in virtually no social activities in college, and for that matter avoids day-to-day activities that require social interaction. By his own admission, Tim never participates in class discussions, even in online discussionTim is so afraid of rejection that he confines himself to his room and his studies. When differentiating schizoid personality from avoidant personality, the PMHNP knows that a primary difference is that: Question: Cory J. is a 23-year-old male being by the PMHNP today for an initial evaluation. He says that he does not think anything is wrong, but his family, including his mother, grandmother, and aunt, have all told him that he must _mentally _ He has unable to hold a job and has as a cook at more than five chain restaurants in the last 6 months. He has no real friendshe says his _friends_ only call him when they need something but never help him. He is currently staying with his grandmother but will soon homeless _unless things change._ While he is telling his story, the PMHNP appreciates that Cory repeatedly includes details that make it hard to understand his point. When asked why he thinks he will 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 couldnt afford to fix it because his tax return was held by the IRS. The PMHNP recognizes that this represents an abnormal: Question: Cory is a 23-year-old male recently in the county correction facility for a 9-month sentence following his third conviction for battery. As part of an early release program, he is to participate in the therapy program. During his initial interview, he is very pleasant and , 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 . a steady job but rather is constantly coming up with money-making schemes. According to family reports is a personality disorder are very likely to: Question: Maxwell is a 75-year-old patient with moderate Alzheimers dementia. She lives with her son and his wife and generally does very well with her day to day activities. The family understands the importance of routine and Mrs. Maxwell maintains a regular schedule of activities including her meals, timed toileting, and recreational activities. Which of the following behaviors should prompt and immediate depression screening for Mrs. Maxwell? Question: The psychological sciences have contributed theoretical foundations to the etiology and management of anxiety disorders from both conceptual and practical perspectives. The concept that anxiety develops in persons who feel as though they are living in a world devoid of meaning is an example of which theoretical foundation? Question: Bowen is a 33-year-old female who presents as a new patient requesting medication for depression. She reports a long history of mood disorders on and off going back to adolescence. She is very articulate in describing her history and reports that neither sertraline nor fluoxetine _ for her._ She was unable to remember the dose or how long she took the medication. With respect to considering Mrs. Bowens medication history, the PMHNP knows that: Question: Dependence is a common feature of many psychiatric disorders. One of the primary distinguishing features that differentiates dependent personality disorder from histrionic and borderline personalities is that: Question: T. is a 39-year-old female being by the PMHNP for a major depressive episode. She is being with SNRI therapy in combination with cognitive behavioral therapy. She is having difficulty achieving remission, and her husband comes with her to this office visit because he is becoming very frustrated. He wants to supportive, but he is finding it very difficult to understand why she is so depressed. M.T. had an episode of depression approximately 2 years ago, but that was when her sister died in an accident. After 6 months of treatment, she seemed to return to normal. This time, her husband points out that she _has nothing to depressed about,_ but she has become so that she has essentially withdrawn from the family. In trying to help M.T.s husband understand the disease process, the PMHNP discusses with him that: Question: Becci is a 31-year-old female who presents to the PMHNP for evaluation after being by her friend who is a patient of the She describes a relatively acute, recent onset of panic attacks. Becci says that _out of the blue_ her heart starts to race, her mouth gets dry, she gets shaky, and feels like she cannot get her breath. She is afraid because her friend has panic disorder and Becci knows that before her friend got treatment, she basically would not leave the house in case an attack happened. The PMHNP recognizes that the immediate priority in assessment for Becci is: Question: The difference between a manic and hypomanic episode is best by all the following except: Question: Janel is a 37-year-old woman who is being as part of a family assessment. Her 10-year-old son is having some behavioral issues in school and has been for evaluation. While interviewing Janel, the PMHNP appreciates that she appears very emotional. She expresses extreme distress at her sons behavior and says she will do anything to help him; they are _best friends._ She is very demonstrative during the assessment and seems unhappy when she is not the center of attention during the evaluation process. She repeatedly talks about her own medical problems, such as recurrent headache and abdominal pain, which her doctors cannot diagnose. Her appearance is very flamboyant, and her dress is more appropriate to a nightclub than a family assessment. Inaddition to managing her sons needs, Janel would likely benefit from: Question: The PMHNP is p;pklm mkkmnjjhh/. to evaluate the parent of one of her existing patients, a 49-year-old woman named Sheri. Sheri reports that her father, a 78-year-old man who lives alone, has always in good health. However, when Sheri went to have breakfast with him this past Sunday, she found her father overtly and he did not even seem to recognize her at first. Sheri is that he has Alzheimers disease, and she is because two days prior he was _completely _ The PMHNP knows that the most likely cause of this presentation is: Question:In documenting a mental status exam (MSE) for Janet, a 54-year-old female, the PMHNP notes that she is bradykinesic, has poverty of speech, is , and appears flat. This includes all the following elements of physical examination except: Question: Jen is a 31-year-old female who presents for care complaining of mood. During the interview, it becomes apparent that she has a long history of depressive symptoms, as well as a long history of socially and feeling generally inadequate. When considering a diagnosis of dysthymia, the PMHNP considers that the core concept of dysthymia refers to sub-affective or subclinical depressive disorder with all of the following except: Question: Which of the following personality disorders is with females with fragile X syndrome? Question: The PMHNP is evaluating Jared, a 47-year-old male who is to care by his wife because _hes not the man I 20 years ago._ According to his wife, she and Jared have been for 20 years, have two children, and have a _normal_ Jared owns a local construction company and their marriage has a solid one, by the typical day-to-day issues that occur in most marriages, but otherwise happy. For the last 23 months, she says Jared has completely . He will get angry for no apparent reason and even a lamp once. He tells stupid and offensive jokes that no one else thinks are funny, and even had someone call the police when he to make inappropriate remarks to a woman in a restaurant. Jared seems unsure what to say, but his wife is adamant that this is a totally different man from the one she has known. The PMHNP knows that Jared should evaluated for: Question: Trudy L. is a 29-year-old female patient who care because she feels like she has no energy. She just had her annual wellness exam and her primary care provider told her that she is in excellent health. Because she about this excessive fatigue, her PCP performed a CBC, CMP, UA and thyroid function tests and was , along with her physical examination, that everything looks normal. Further discussion reveals that Trudy is having some relationship challenges with her boyfriend of 2 years and this seems to _spilling over_ at work, where she is having persistent conflict with her supervisor. Ultimately the PMHNP diagnoses Trudy with major depressive disorder, mild, single episode. The PMHNP and Trudy discuss treatment options, and Trudy would really like to try nonpharmacologic interventions. Which of the following represents the best approach for Trudy? Question: Maurice is a 22-year-old male who is being for major depressive episode. He presents today for a follow up visit. He was started on sertraline 50 mg daily 4 weeks ago, and 2 weeks ago, his dose was to 150 mg daily. Today he is because he doesnt really feel much symptom improvement, and he thinks he needs something else. The best response to Maurice is to tell him that: Question: Depressive personality disorder exists along the spectrum of dysthymia and major depressive disorder, but it is different from these two in that: Question: Karen is a 19-year-old female who has been to care after being in the emergency department following a violent sexual assault. She was working late one evening at the shopping mall and alone to her car after dark. She was , , and thankfully a passerby saw her lying in some bushes and called 911. Initially she was resistant to mental health care, but now, 2 months later, she feels as though she needs help because she is experiencing a collection of symptoms including flashbacks, dreams of the assault, palpitations, anxiety, and a sense that she is watching the assault happen to her This sense of watching the assault as if she was an observer is characteristic of which diagnostic domain of PTSD? Question: Melissa is a family nurse practitioner who is in a PMHNP program and is beginning her first clinical rotation. After being to the practice processes and procedures, she is preparing for her first solo interview of a patient who is presenting to the practice to establish care. Melissa knows that, unlike her experience as a primary care nurse practitioner, the first office visit with a psychiatric patient should : Question: The International Study of Expert Judgment on Therapeutic Use of Benzodiazepines and Other Psychotherapeutic Medications was designed to gather systematic data on the opinions of leading clinicians concerning the benefits and risks of benzodiazepines and alternative anxiety treatments. Which of the following best characterizes the majority opinion of this group? Question: Differentiating post-traumatic stress disorder (PTSD) from panic disorder and anxiety disorder can challenging. Which of the following provides the strongest support for PTSD vs the other two differential diagnoses? Question: John is a 41-year-old male who presents for management of heroin addiction. He has a long history of opiate abuse spanning decades and has had several unsuccessful attempts at recovery. Because of his lifestyle, he has a variety of chronic health problems, including cardiomyopathy and stage 2 chronic kidney disease. He currently takes several psychiatric medications for mood disorder. When considering methadone maintenance as a mechanism of treating his opiate addiction, the PMHNP knows that if he requires more than 100 mg of methadone at the start of therapy he should have a baseline: Question: During the interview of Kevin, a 42-year-old male who presents for treatment because of marital problems, the PMHNP responds to his tears by gently moving a box of tissues toward him. This is a facilitating intervention of interview known as: Question: When evaluating the laboratory assessment of a patient with alcohol use disorder, the PMHNP may reasonably expect to find all of the following abnormalities due to chronic alcohol use except: Question: Henderson is a 69-year-old man who presents for evaluation and care for depression. His wife 6 months ago following a difficult 2 years with breast cancer. His primary complaint is that he just does not look forward to anything anymore. He cannot get in his children and grandchildren, he no longer enjoys any of his hobbies because he and his wife to do them together. He does not sleep well, and wakes up frequently during the night. He also admits to thinking more and more about dying himself, although he expressly denies suicidal ideation. His medical history is significant for coronary artery disease, osteoarthritis, hypothyroidism, hypertension, and dyslipidemia. He also has atrial fibrillation and is on warfarin for emboli prophylaxis, but he does not remember the names of all of his other medications. When considering pharmacotherapy for Mr. Henderson, the PMHNP considers that which of the following SSRIs is safest with respect for potential drug interactions? Question: The PMHNP is called to the acute care unit to evaluate a patient who is admitted after being in by his friends. They were at a party where there were numerous drugs of abuse as well as alcohol. The patient cannot provide a history, and his friends are unclear as to which drugs he . Physical examination reveals a patient who is diaphoretic, tremulous, has a pulse of 130 bpm, dilated pupils, and cannot perform fine motor tasks. These physical findings are most consistent with which type of intoxication? Question: Kevin is a 24-year-old male who seeks treatment for anxiety. He thinks he has an anxiety disorder because he has a lot of the same symptoms that his mother does, and she takes medications for anxiety. He reports _constantly ,_ irritable, and not sleeping Kevin says he always has energy, but its not a good kind of energy. He does not have isolated panic attacks; he is always just _amped up._ He denies any substance abuse, and he does not smoke cigarettes. When considering organic causes of his symptoms, the PMHNP must evaluate his: Question: A biological perspective, all of the following neurotransmitters are implicit in the anxiety response except: Question: Laura T. is a 27-year-old female who has been for psychiatric evaluation. She has no significant psychiatric or medical history and denies any history of substance abuse, but she is here because she is persistently having olfactory hallucinations. For the last 3 months, she has been having this progressive sense of smelling particularly foul odorsfeces, rotting food, trash with no obvious cause. She the appointment because she had an uncle who had schizophrenia and he to have hallucinations too, although he was mostly hearing voices. The PMHNP knows that a priority of assessment includes a: Question: Marcus is an 18-year-old male for care by his parents. It is time for Marcus to begin exploring colleges and he flat out refuses to do so. Both Marcus and his parents admit that he has had a rather solitary lifestyle. He has been home since the eighth grade. According to his parents, he is extremely intelligent and in junior high it became very difficult for him to in school. He was very uncomfortable in the school setting and it was counterproductive to learning, so the parents were amenable to home schooling. However, now they want him to go to college, but he will not discuss it. When considering differential diagnosis, the PMHNP considers all of the following except: Question: Chantel is a 19-year-old female who presents for care because she thinks she is bipolar. During her initial interview, she admits that she has a long history of feeling like she was the person in the family of whom there were always high expectations, and she was never able to express concerns or feelings of inadequacy. When why she thinks she is bipolar, she says she gets very moody. She was at the grocery store last week and and fell. While waiting for help, she could not control her anger and up to swipe all the food off of the shelves. She has been from jobs because of her uncontrollable temper; she sometimes _just cant around certain _ Chantel also reports that at times she will go two full days and nights unable to sleep, and that her mind keeps racing and she cant _shut it down._ When this happens, she just gets up and does things around the house. Finally, Chantel reports that she cannot hold onto money at all. Whenever she gets a paycheck, she immediately spends it on things that she acknowledge

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