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NURS 6670 Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults
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NURS 6670 Midterm Exam
Question 1
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:
Clothing
Speech pattern
Anger
Anxiety
Question 2
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 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
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 3
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?
SSRIs
TCAs
Antiadrenergics
Antipsychotics
, Question 4
Alexa is a 27-year-old female 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?
Histrionic
Narcissistic
Borderline
Schizoid
Question 5
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:
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
Question 6
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 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:
Stuttered
Increased
Childlike
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:
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
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?
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