NRNP 6670/NRNP6670 Midterm Exam Questions With Answers Latest 2023/2024 (Score A+)

NRNP 6670/NRNP6670 Midterm Exam Questions With Answers Latest 2023/2024 (Score A+). Becci is a 31-year-old female who presents to the PMHNP for evaluation after being referre d by her friend who is a patient of the practice. 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 1 out of 1 points the house in case an attack happened. The PMHNP recognizes that the immediate priority in assessment for Becci is: Selected Answer: A thorough physical examination Answers: A thorough physical examination A family history of mental health disease A urine drug screen An assessment for phobic disorder Response Feedback : (a) is the correct answer. While these are elements of a panic attack, there are a variety of organic conditions that can cause these symptoms. Becci needs a physical examination and appropriate laboratory assessment to rule out physiologic causes of her symptoms, such as thyroid disease. The remaining elements above will all be part of the mental health assessment once physical health is determined. ● Question 3 Mrs. Bowen is a 33-year-old female who presents as a new patient requesting 0 out of 1 points 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 ―worked for her. She was unable to ‖ remember the dose or how long she took the medication. With respect to considering Mrs. Bowen’s medication history, the PMHNP knows that: Selected Answer: Some forms of recurrent depression are best managed with nonpharmacologic strategies Answers: 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 Respons e Feedback : (b) is the correct answer. A common mistake among clinicians is to accept the depressed patient’s self-report of medication accuracy. Depressed patients frequently overemphasize the negative and minimize the positive and may genuinely have a misimpression of their medications effectiveness; similarly, unrealistic expectations may skew their impression of medication response. An SNRI may ultimately be the most appropriate choice, but the PMHNP should not base this primarily on the patient’s self-report of SSRI response. This should not be perceived as a purposeful mischaracterization – the patients are not usually trying to misrepresent thing; they are reporting their genuine impression. Finally, recurrent depressions spanning decades will most likely require pharmacotherapy along with some form of nonpharmacologic intervention for best outcomes. ● Question 4 1 out of 1 points 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: Selected Answer: Psychother apy Answers: Diazepam Pimozide Psychother apy Group therapy Response Feedback : (c) is the correct answer. Danielle’s symptoms and history are consistent with paranoid personality disorder. Psychotherapy is the treatment of choice for this condition. These patients often do not do well in group therapy as a rule, although for some it can increase social skills. Pharmacotherapy is not a primary mechanism of treatment, but when comorbid agitation and anxiety occur, diazepam may be used. In some patients with quasidelusional thinking, pimozide has been helpful. ● Question 5 A 22-year-old male patient is started on sertraline 50 mg p.o. daily after 1 out of 1 points 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: Selected Answer: When symptoms are preceded by antidepressant therapy, a diagnosis of bipolar does not apply Answers: 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 Response Feedback : (a) is the correct answer. Consistent with DSM-5 criteria, a manic episode that emerges in response to an antidepressant does not constitute bipolar disorder. If these symptoms occur beyond the natural washout period of the sertraline, then bipolar may be appropriate. Symptoms have occurred long enough, as diagnostic criteria require 1 week of symptoms most of the day. An assessment of social and occupation impact will be helpful, but as his boss has already commented, this appears possible. While there is a physiologic adaptation to sertraline, that does not include symptoms described here. ● Question 6 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 1 out of 1 points 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: Selected Answer: Significant impairment at work Answers: A history of racing thoughts Difficulty interacting with others Extremely high expectations of self Significant impairment at work Response Feedback : (d) is the correct answer. OCD frequently leads to difficulty at work because the symptoms interfere with the patient’s ability to successfully complete the workday; conversely, patients with OCPD frequently are praised at work because of their devotion to perfectionism. Other differences include that persons with OCPD are usually impeccably dressed, know their thoughts and actions are unreasonable or inappropriate. Conversely, there are many similarities between the personality disorder and the anxiety disorder, and they include (a) through (c). ● Question 7 1 out of 1 points 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: Selected Answer: Appearanc e Answers: Appearanc e Motor activity Mood Affect Response Feedback : (a) is the correct answer. Appearance and behavior refer to a general description, such as apparent age, style of dress, jewelry, grooming and hygiene. None of these are noted here. Janet’s motor activity is bradykinesia, her mood is depressed, and her affect is flat. ● Question 8 When performing a psychiatric assessment of an elderly patient with Alzheimer’s dementia, the PMHNP recognizes that: 1 out of 1 points Selected Answer: All of the above. Answers: 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. Response Feedback : (d.) is the correct answer. Even in clearly impaired patients, in which a big part of the history may come from a caregiver, the patient should be interviewed alone to preserve the privacy of the relationship and allow the patient the opportunity to discuss things that he or she would not discuss in front of others, such as suicidal or paranoid ideation. While some of the history may come from a caregiver, all elements are equally important, and the demented patient’s contribution may easily be more important to the chief complaint. A sexual history is important as history and fantasies may contribute to the current issue. ● Question 9 When differentiating a major depressive episode from dysthymic disorder, the PMHNP considers that: Selected Answer: Dysthymia is more subjective in its presentation than depression Answers: 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 1 out of 1 points Respons e Feedback : (c) is the correct answer. While dysthymia overlaps with depression, it is different in that symptoms tend to be more prevalent than physical findings; disturbances in appetite, libido, and psychomotor function rarely occur. The cognitive theory of depression also applies to dysthymia; hospitalization is rarely indicated in dysthymia, and while insight-oriented therapy has been historically utilized, objective evidence supports cognitive, behavioral, or pharmacotherapy. ● Question 10 During the interview of Kevin, a 42-year-old male who presents for treatment 1 out of 1 points 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: Selected Answer: Acknowledgem ent Answers: Reinforcement Reassurance Encouragemen t Acknowledgem ent Respons e Feedback : (d) is the correct answer. This is a form of nonverbal acknowledgement of emotion and often leads the patient to sharing more feelings. Reinforcements are those brief phrases that urge the patient to continue, such as ―I see or ―go on. Reassurance is a technique by ‖ ‖ which the therapist provides accurate information about the illness that can decrease anxiety. Encouragement characterized by providing a realistic assessment of the patient’s progress or positive contribution to the interview. ● Question 11 1 out of 1 points 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? Selected Answer: Existential Answers: Psychoanal ytic Behavioral Existential Cognitive Response Feedback : (c) is the correct answer. From an existential perspective, there is no specific identifiable stimulus for anxiety; a patient is chronically anxious as they sense that their lives and the universe have no purpose. Psychoanalytic theory suggests that anxiety is a product of an unconscious sense of danger. Behavioral theory suggests that anxiety is a learned, classic-conditioning response. Cognitive theory suggests anxiety may be related to maladaptive thought patterns. ● Question 12 Which of the following is a true statement with respect to the treatment of narcissistic personality disorder? Selected Answer: Both serotonergic drugs and lithium are useful Answers: 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 1 out of 1 points Response Feedback : (b) is the correct answer. Treatment of this disorder is very difficult as patients must acknowledge and eschew their narcissism before any real therapeutic progress can be made; however, these patients are prone to both depression and mood swings for which both serotonergic drugs and lithium have been successful. Psychoanalytic therapy has been advocated, but there is no validating research. Group therapy has been advocated for by some clinicians, although more research is needed. There is no evidence that immobilized patients do better—this concept is true of antisocial personality disorder. ● Question 13 0 out of 1 points 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: ‖ Selected Answer: History and symptoms are most consistent with antisocial personality disorder Answers: 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 Response Feedback : (d) is the correct answer. Typical antisocial personality disorder history extends into adolescence. Fletcher’s behavior appears to have changed following his substance-abuse behaviors, consistent with a diagnosis of substance-abuse disorder—when this is the case, a diagnosis of antisocial personality disorder is not warranted. Abnormal EEG and neurological soft signs are more common in antisocial personality disorder. A stress interview is a technique in which the patient is confronted aggressively with the inconsistencies in his own history and is a therapeutic technique in antisocial personality disorder —again, not appropriate in Fletcher’s case. ● Question 14 1 out of 1 points 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: Selected Answer: The physiologic symptoms of withdrawal may require a short-term hospitalization Answers: 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 Response Feedback : (a) is the correct answer. Unlike opiates, alcohol, or sedative-hypnotics, cocaine withdrawal does not produce physiologic symptoms that require inpatient withdrawal; occasionally a patient may need to be placed in a residential or inpatient setting just to keep them away from social settings where they can obtain the drug. There are no medications to help with withdrawal. The patient does need to understand that fatigue, dysphoria, and depression may occur. The depression can be severe, and patients should be followed for its development. The primary barrier to withdrawal is the intense cravings that patients experience, particularly as there are no other drugs to help with these symptoms and the patients know that even a small dose of cocaine will attenuate the symptoms they are having. ● Question 15 1 out of 1 points Which of the following personality disorders is associated with females with fragile X syndrome? Selected Answer: Schizoty pal Answers: Borderlin e Narcissis tic Depende nt Schizoty pal Response Feedback: (d) is the correct answer. Schizotypal personality disorder is frequently diagnosed in females with fragile X syndrome. This association is not evident among the other 9 personality disorders.