NURS 6670 Final Exam Collette is a 23-year-old female who presented for emergency care with her mother because her behavior has become increasingly erratic and caused her to lose her job. Her mother reports that she had never done anything like this in the past, but about 3 months ago, her boyfrien...
collette is a 23 year old female who presented for emergency care with her mother because her behavior has become increasingly erratic and caused her to lose her job he
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NURS 6670 Final Exam
Collette is a 23-year-old female who presented for emergency care with her mother because
her behavior has become increasingly erratic and caused her to lose her job. Her mother
reports that she had never done anything like this in the past, but about 3 months ago, her
boyfriend of 3 years broke up with her, and Collette began to express unrealistic beliefs that her
boyfriend wanted to drive her crazy and hurt her. A gentleman trying to hail a taxi accidentally
bumped into her this morning, and she started screaming that her ex-boyfriend had hired the
man to throw her into the street under a car. Collette is on a 2-week suspension from her job as
a restaurant server because she was combative to a customer— she accused him of colluding
with her ex-boyfriend to get her fired. After this morning's incident, her mother was so worried
she brought her to the emergency room. Her appearance is disheveled, she is clearly hyperalert
and is crying that her boyfriend must have converted her mother to work against her. Head
imaging, screening lab, and a toxicology screen are negative. A leading differential for Collette
is:
- Acute psychotic episode
Rationale: Collette's differential diagnosis is an acute psychotic episode, this disorder causes
abnormal ideas and perceptions. Two of the main symptoms are delusions and hallucinations.
Delusions are false beliefs, such as that someone is against them and hallucinations are false
perceptions, such as listening, or feeling something that does not exist.
Jake and Laurie are a young married couple who have been referred to mental health
counseling because Jake is having disturbing sleep events. Laurie reports that on more than one
occasion she has awakened to find Jake having what appears to be a panic attack, but he
doesn't seem to realize it. When he finally wakes up, he is confused and doesn't really
understand what happened, although he does have a sense of intense fear. This has happened
twice in the last 2 weeks, and the last time Laurie heard him screaming. Jake is now a bit afraid
to go to sleep and as a result does not feel well the next day. The PMHNP recognizes that sleep
terrors in adults:
- Are often associated with trauma or psychiatric problems
Jack is a 27-year-old male who has a history of paranoid schizophrenia that first became
apparent approximately 10 years ago. He developed paranoid delusions and eventually
decompensated to the point that he required inpatient stabilization. At the time, he was
started on conventional antipsychotics, but due to intolerable adverse effects he was switched
to haloperidol. It worked well, but whenever he stopped taking it, symptoms would recur. After
several hospitalizations, he was stabilized. The neurophysiologic theory of schizophrenia
suggests that Jack's symptoms were a result of:
,- Increased dopamine activity in the mesolimbic pathway
Johanne is a 22-year-old female who is being treated for narcolepsy. She is attempting to
implement a regimen of forced daytime naps in an effort to manage her condition without
pharmacotherapy as she is generally averse to taking medications. While following Johanne, the
PMHNP should be alert to signs and symptoms of
- Depression
Narcolepsy
- A sleep disorder characterized by uncontrollable sleep attacks. The sufferer may lapse
directly into REM sleep, often at inopportune times.
The PMHNP is asked to prepare a presentation for non-nursing health care workers in a local
long-term care facility on the various causes of cognitive impairment in the elderly. A case
presentation approach is used to reinforce principles of identifying delirium, which needs to be
reported to the patient's attending provider right away. The case should emphasize which of
the following features as being closely correlated with delirium?
- Rapid onset
Valerie is a 27-year-old woman who has been referred by her primary care provider. She was
initially diagnosed with major depressive episode following a breakup with her boyfriend of 7
years. They moved into a house together 1 year ago, but within a few months the boyfriend
moved out. Valerie was unresponsive to medication for depression and was referred to the
mental health clinic. During this initial psychiatric evaluation, the PMHNP learns that a primary
reason for the breakup was that Valerie had an extensive routine every night of repeatedly
checking every door and window in the home to ensure that they were locked. Valerie's
nighttime routine is exhaustive and involves checking every door and window at least four
times. She has a remote history of being attacked in her home while alone and states that she is
unable to go to bed until she is certain that every door and window is locked. When considering
diagnostic criteria for OCD, the PMHNP needs further assessment to ascertain which diagnostic
criteria?
- The patient has good or fair insight with respect to the appropriateness of her behaviors
Michael is an 18-year-old male who is presented to care at the urging of his parents. He has
never had any significant medical or psychiatric problems in the past, but during his first
, semester at college he has developed a very alarming pattern of excess sleep. He is missing
classes and is in danger of losing a scholarship. He is sleeping normally at night but apparently is
having these very long episodes of napping and sleeping during the day. When he is awake, he
tends to be rather withdrawn. His parents have taken him to their family practitioner as they
thought he might be using drugs. A full exam, laboratory assessment, and toxicology screen are
all normal, and there is no apparent cause for this sleepiness. While very rare, the PMHNP
considers Kleine-Levin syndrome and further assesses for coincident onset of:
- Hypersexuality
Kleine-Levin syndrome
- recurrent hypersomnia with daytime sleepiness, hyperphagia, hypersexuality, aggression.
Kleine Levin syndrome is a rare disorder characterized by recurrent episodes of excessive sleep
(hypersomnia) along with cognitive and behavioral changes. Affected individuals may sleep for
up to 20 hours per day during an episode. These episodes usually last for a few days to a few
weeks.
The primary differentiating feature between mild cognitive impairment (MCI) and Alzheimer's
dementia is:
- Presence or absence of functional impairment
Physiologic assessment of patients with paraphilias has demonstrated that most of them have:
- Abnormal hormone levels
Donna is a 41-year-old woman who is being evaluated at the request of her primary care
provider for obsessive compulsive disorder. Which of the following aspects of Donna's family
medical history should prompt an immediate referral to a neurologist?
- Mother died from Huntington's chorea
With respect to the treatment of obsessive compulsive disorder, which of the following
statements best characterizes the role of psychotherapy?
- Best treatment outcomes occur when patients combine psychotherapy with
pharmacotherapy.
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