NURS 6670 final exam Questions & Answers 2024 Update | Rated A+

NURS 6670 final exam Questions & Answers 2024 Update | Rated A+ Bipolar disorder Acute psychotic episode Schizophreniform disorder Post-traumatic stress disorder 1 points QUESTION 2 1. 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 Represent a disorder of REM sleep May be a symptom of temporal lobe epilepsy Is treated with a cycle of sleep deprivation Increased dopamine activity in the mesolimbic pathway Increased dopamine activity in the mesocortical pathway Increased glutamate in the prefrontal cortex Increased glutamate in the hippocampus Suicidality Depressio n Hyperpha gia Disinhibiti on Perceptual disturbances Rapid onset Agitation Abnormal sleep patterns The patient has tried unsuccessfully to suppress the urge to repeatedly check locks The compulsive activities are time-consuming to the extent that at least 1 hour daily is spent on them The disturbance is not better explained as the symptoms of another mental disorder The patient has good or fair insight with respect to the appropriateness of her behaviors Narcolepsy Mood disorder Hypersexua lity Alcohol abuse The presence of the apolipoprotein E4 gene Performance on objective neuropsychiatric testing Presence or absence of functional impairment Atrophy of the hippocampal volume Abnormal hormone levels Hard or soft neurological signs Chromosomal abnormalities Electroencephalogram (EEG) abnormalities Father committed suicide at age 38 Mother died from Huntington’s chorea Sister has temporal lobe epilepsy Brother has profound eczema Best treatment outcomes occur when patients combine psychotherapy with pharmacotherapy Psychotherapy is superior to behavior therapy as a nonpharmacologic adjunct to medications Psychodynamic exploration of a patient’s resistance to treatment may improve compliance to therapy There is no apparent benefit to psychotherapy in the management of obsessive compulsive disorder Gender dysphoria Intersex condition Sexual identity disorder Paraphilia Sleepwalkers do not have REM-mediated paralysis Sleepwalkers are acting on the dream imagery RBD patients do not respond to pharmacotherapy RBD may be due to a variety of brain abnormalities Very aware of the dysfunction Afflicted by poor attention and concentration Good at concealing disability Joyful at accomplishing tasks 1 points QUESTION 15 1. Several medical disorders can produce symptoms of obsessive-compulsive disorder (OCD). Which of the following findings in a patient with new onset OCD should prompt an evaluation for a neurologic cause of symptoms? Family history of neurological disease Poorly controlled hypertension Age 40 at presentation Lack of response to SSRIs 1 points QUESTION 16 1. Which of the following is a true statement with respect to obsessive-compulsive disorder? Most clinical drug trials support the hypothesis that dysregulation of the serotonergic system is involved in symptom formation Between 50 and 75% of patients with obsessive-compulsive disorder (OCD) had premorbid obsessive-compulsive personality disorder (OCPD) Behavioral theory suggests that development of obsessive thoughts and compulsive behaviors are a result of respondent conditioning Most affected individuals are diagnosed between the ages of 25 and 40 1 points QUESTION 17 1. Joyce is a 30-year-old female patient who was recently diagnosed with schizophrenia after being referred for mental health evaluation by the police. She demonstrated paranoid delusions that ultimately led to such disruptive behavior at her place of work that the police were called. Her husband was able to provide a history consistent with prodromal symptoms, and in retrospect her disorganized thought and poor insight were evident over the last few months. She was initially stabilized on IM Zyprexa (olanzapine) and has been maintained on oral Zyprexa for the last 2 weeks, and has been on 10 mg daily for 1 week. Today at follow- up she demonstrates mild improvement. Her hygiene and appearance are much improved. Obtaining an olanzapine level Increasing the dose of Zyprexa Cross titrate another antipsychotic Add a mood stabilizer 1 points QUESTION 18 1. Recurrent isolated sleep paralysis is characterized by the awareness of normal REM- mediated paralysis in the partially conscious state. It is a feature of normal REM sleep, and lifetime occurrence is estimated to be as high as 50%. While counseling patients about this condition, the PMHNP correctly states all the following except: First-line therapy includes ensuring adequate sleep Shift work can increase the likelihood that this occurs People experience this should not be touched It is among the tetrad of narcolepsy symptoms 1 points QUESTION 19 1. A wide variety of sleep-wake disorders are referred to the PMHNP for assessment and management. A contemporary approach to managing insomnia centers around: Diagnosing and managing underlying causation Providing relief and managing symptoms Focusing on nonpharmacologic therapies Differentiating “tiredness” from “sleepiness” 1 points QUESTION 20 Lack of precipitating factors Neurological signs Physical assault Age of onset 1 points QUESTION 21 1. Shireen is a 21-year-old transgender female who has been through an exhaustive counseling program and is ready to start hormone therapy with estrogen, progesterone, and testosterone-blocking agents. When counseling her specifically about the risks, benefits, and required monitoring of hormonal therapy, the PMHNP advises Shireen that: Her ability to conceive will not be adversely impacted There is a significant risk of developing benign prolactinomas Smoking cigarettes while on estrogen therapy increases risk of thrombosis If breast augmentation is planned, it should be performed prior to hormone therapy 1 points QUESTION 22 1. John is a 20-year-old male who is referred to treatment by his father. The two of them live together following the murder of John’s mother 6 weeks ago. It was a tragic occurrence; John’s mother was a nurse at an inner-city hospital and was killed as an innocent bystander in a drive-by shooting. John was very close to his mother, and in the last 3 weeks he has been increasingly distraught. His dad says he did not cope well from the beginning, but for the last 2 weeks he has been agitated, combative, and is hearing voices telling him that he could have saved his mother. He has become so agitated that his father brought him to the emergency room. The PMHNP knows that immediate treatment for John should include: Electroconvulsive therapy IM antipsychotics Benzodiazepines Antidepressants Celibacy Tourette’s disorder Marital discord Obsessive-compulsive personality disorder Prodrome of negative symptoms, duration > 1 month, early age of onset Absence of mood disorder, two or more psychotic symptoms, duration > 6 months Progressive decline in social and occupational function, insidious onset, complete resolution of symptoms Rapid and acute onset, return to baseline in < 6 months, occurs in adolescents and young adults Olfactory reference syndrome Obsessive compulsive personality disorder Temporal lobe epilepsy Sinus inflammation Mental status examination is normal Hallucinations consistent with occult cancer A willingness to consider objective evidence that her belief is unrealistic Family history of psychotic or mood disorder Childhood onset Yielding to compulsions Precipitating event Some acceptance of symptoms Rabies encephalitis Neurosyphilis Lyme disease Herpes simplex encephalitis Psychophysiological insomnia Conditioned insomnia Paradoxical insomnia Idiopathic insomnia Participating in community awareness programs and promoting identification of sexual offenders in the neighborhood Designing a screening tool to identify children 13 years of age and younger at high risk for being targeted by pedophiles Volunteering one afternoon a week to counsel in a comprehensive center for children who have been victimized Researching strategies to promote best long-term success treatment modalities Metformin (Glucophage) Clopidogrel (Plavix) Metoprolol (Lopressor) Lisinopril (Lotensin) Unlike men, women may not feel interest or desire until after arousal The disorder rarely occurs in older men but is common in older women Symptoms occur more commonly due to hormone deficiencies in men Duration of symptoms to support diagnosis is longer in women Memory Visuospatial ability Reading and writing ability Abstraction Diarrhea Bradycardia Sedation Urinary incontinence Cognitive relabeling Diffusing sleep worry Anxiolytics Changing environment 1 points QUESTION 36 1. The PMHNP is preparing a presentation for a primary care conference. The topic is “Recognizing Schizophrenia: Common Signs and Symptoms Encountered by the Primary Care Provider.” A critical point to stress to primary care clinicians is that: Olfactory and gustatory hallucinations are unusual and should prompt evaluation for a neurological disorder A precox feeling as correlated with a diagnosis of schizophrenia has a demonstrated sensitivity of 83% Disorders of thought content are pathognomonic for schizophrenia and are an indication to begin antipsychotics Premorbid and prodromal signs and symptoms have a high predictive validity and should prompt a psychiatric referral 1 points QUESTION 37 1. The PMHNP is formulating a diagnosis for Peter, a 24-year-old man who was admitted for management of acute psychoses. He believed that he was the Holy Ghost of the Christian Trinity. According to his mother and father, he did not have any psychiatric symptoms or history throughout childhood and adolescence, but after college, he began to develop “issues” characterized by extremes of mood in which he would be too depressed to attend classes for weeks at a time followed by a rebound in which he would go partying, stay awake for days at a time, and go on ridiculous shopping sprees. When considering a diagnosis of schizoaffective disorder, the PMHNP attempts to establish that: His religious delusions are of at least 4 weeks’ duration and have produced social or occupational impairment The delusions at some point have occurred for 2 weeks absent a major mood episode Symptoms respond favorably to a combination of antipsychotic medications and mood stabilizers There is evidence of premorbid or prodromal symptoms prior to the psychotic episode Schizophrenia Major depressive episode General medical condition Parkinsonism 1 points QUESTION 39 1. Luz is a 24-year-old female who is being evaluated at the strong urging or her mother and the family primary care provider. According to the mother, Luz has been progressively demonstrating obsessive thoughts and compulsive behaviors centering on religion. She is preoccupied with the concept of heaven and hell, and she often becomes very distressed that she is going to go to hell when she dies. The mother also reports that Luz appears to be compulsive about reading her Bible and performing prayers and other rituals several times a day. The PMHNP must perform a detailed history and examination to differentiate obsessive- compulsive disorder (OCD) from: Obsessive compulsive personality disorder Psychosis Depression Schizoid personality disorder 1 points QUESTION 40 1. Dual-sex therapy is a therapeutic approach to sexual dysfunction in a marital dyad or relationship that is believed to result from disharmony or misunderstanding in the relationship. This is most effective in couples when: The therapeutic team takes the lead in directing activities There is no other psychopathology in either partner Individual therapy for the partner with the dysfunction is unsuccessful Each partner comes to therapy with an open mind to sexual play 1 points QUESTION 41 1. John is a 19-year-old male who is self-referred for care after being prematurely discharged from the military. He is vague as to the details of his discharge, but it appears he He is only sexually attracted to men He has a desire for gender reassignment surgery Cross-gender behavior was evident before puberty John is unable to obtain an erection with partners of either gender 1 points QUESTION 42 1. Kasey is a 26-year-old male who is referred for emergency psychiatric evaluation in the local community emergency room. His girlfriend came home from work unexpectedly and found him in the bathtub with multiple longitudinal cuts on both wrists. She called 911 and he was stabilized in the ED; the injuries were not serious, and now he is pending psychiatric evaluation. When the PMHNP came into the room, he noticed that Kasey unbuttoned and rebuttoned his shirt four times before settling down to the interview. He presented as depressed and tearful, and admitted to feelings of hopelessness and worthlessness. He admits that he doesn’t really feel connected to anyone; he has always been a loner, and last night he tried to kill himself because life just was not worth living. In addition to his suicidal ideation, the PMHNP recognizes that he needs to be further evaluated for: Major depressive episode and obsessive- compulsive disorder Bipolar disorder with psychotic features Dysthymia and borderline personality disorder Obsessive compulsive disorder and schizoid personality disorder 1 points QUESTION 43 1. Jack is a 19-year-old male who is being treated for obsessive-compulsive behavior. He has just begun his mission as a member of the Church of Jesus Christ of Latter Day Saints, and his partner has encouraged him to come to care due to his compulsive cleaning behaviors. Jack has had a very difficult time with treatment; after several sessions, it is apparent that he is having obsessive sexual thoughts with which he is not comfortable. Jack would like to avoid pharmacotherapy if he can, and is interested in exploring psychotherapeutic interventions. The PMHNP refers Jack to therapy and discusses with him that the psychodynamic theories of OCD include: Intolerance of the nuclear family to compulsive rituals The drive to seek secondary gain because of compulsive behavior Abnormalities related to the anal-sadistic phase of development A disproportionate ratio of concomitant personality disorders The subtype; exhibitionism is a very uncommon form of paraphilia The fact that Jaime is female; almost all patients with paraphilia are male The inability to experience arousal or orgasm any other way The onset before age 18 His cognitive function will likely decrease 10–15% per year The diagnosis is not stable and he may revert to normal function Cholinesterase inhibitors, such as donepezil, will improve memory but not cure the condition There is no identified link between mild cognitive impairment and Alzheimer’s dementia Antianxiety agents have been successful in some patients This is most often due to issues in the relationship and dual-sex therapy is indicated Insight-oriented psychotherapy is necessary to help him identify unconscious antecedents to his behavior This is probably one symptom of an underlying personality disorder and requires treatment of the primary problem 1 points QUESTION 47 1. In addition to the diagnostic criteria observed in patients with schizophrenia, physical examination of these patients is frequently characterized by: Hyperreflexia Saccadic movement Rheumatoid arthritis Type 1 diabetes mellitus 1 points QUESTION 48 1. D.M. is a 21-year-old male who presents for admission with his mother. He reports that he “cannot get himself together.” He is disoriented x 3 and his thought processes are chaotic. His speech is disorganized, he is easily distracted, and he appears to be rather agitated. He admits to both visual and auditory hallucinations over the last few weeks, and says he can “hear through the walls.” He was unable to sit still during the evaluation, often getting up and pacing the room, looking out of the windows, and then appearing to listen to something no one else could hear. According to his mother, his behavior has been bizarre for weeks; he has been wandering the neighborhood aimlessly, and reports that he was raped by a male neighbor. His mother finally brought him to the hospital. He appears unaware of his circumstances. D.M. is a poor historian, but does admit to drug and alcohol use on and off for several years. According to his mother, he had a scholarship to college, but it was withdrawn last semester when he stopped going to classes. A screening laboratory assessment is within normal limits, and the PMHNP considers a diagnosis of schizophrenia. D.M.’s presentation is most consistent with which type? Paranoid Disorganized Undifferentia ted Catatonic Chronother apy Photothera py Tasimelteon Zaleplon Impaired visuospatial skills Depressed mood Dysarthria Aphasia Major depressive disorder Mild cognitive impairment Vascular dementia Delirium 1 points QUESTION 52 1. Mr. Levinson is a 41-year-old man who is under care of the PMHNP for mood disorder and insomnia. His mood disorder is currently well managed, but he continues to complain about trouble sleeping. He says the primary issue is that he cannot seem to get comfortable because he has a recurrent sensation of ants or bugs crawling all over his legs. He cannot relax and sleep because he is constantly moving his legs trying to get comfortable. The PMHNP recognizes that: This may be tactile hallucination due to his mood disorder He needs laboratory assessment of iron, folic acid, and ferritin Alcohol, hot baths, and leg massage should be avoided before bedtime A polysomnography study should be obtained 1 points QUESTION 53 1. Amnestic disorders have a wide variety of potential causes, including vitamin and mineral deficiencies, infectious diseases, substance-related causes, and structural damage. The shared feature is that many of these causes tend to affect the: Cerebellum Prefrontal cortex Temporal lobe Amygdala 1 points QUESTION 54 1. With respect to the negative symptoms of schizophrenia, all of the following statements are true except: Negative symptoms are a more important determinant of long-term function Conventional antipsychotics are more effective in controlling them as compared to atypicals They are a result of decreased dopamine in the mesocortical pathway A prodrome of negative symptoms often precedes psychotic episodes Aggressive control of vascular disease Cholinesterase inhibitors Psychodynamic therapy Thiamine administration Exhibitionism toward boys Fondling the genitals of boys Vaginal penetration of girls Anal penetration of girls Is depressed Is demonstrating deterioration Had a catastrophic reaction Has an infection 1 points QUESTION 58 1. Jenna is 21-year-old female who is referred to college behavioral health services by her academic advisor following an advising session that made the advisor very uncomfortable. Jenna indicated that she wanted to change her major to religious studies. Jenna says that she was surfing the Internet trying to find an affordable used car, but every website she saw contained hidden messages just for her. These messages told her that she needed to find the religious meaning in her life and that she should start by redirecting her college pathway. The PMHNP recognizes that this represents: Cosmic identity Magical thinking Loss of ego boundaries Disordered form of thought 1 points QUESTION 59 1. Maureen is a 23-year-old female who self-refers to mental health because she is struggling with a recent diagnosis. She recently had appendicitis, but during the diagnostic CT scan she learned that she had cryptorchid testes, and now she is distressed over not knowing if she “is a man or a woman.” She says that she has always been a bit of a tomboy, but that she has never thought of herself as a man, or as wanting to be a man. She has had a boyfriend for 2 years, and she is terrified that if he finds out he will break up with her. She admits that she has never menstruated, but her mother took her to the doctor when she was 16 and “no one seemed worried about it.” The PMHNP recognizes that Maureen’s diagnosis is likely: Androgen insensitivity syndrome Turner’s syndrome Fragile X syndrome Klinefelter’s syndrome Maintaining a regular exercise schedule Reading a book in bed with no distractors Having a light snack at bedtime if hungry Ensuring that the bedroom is cool A mood stabilizer An antipsychotic Behavior therapy Psychotherap y Constipation and dry mouth Nausea and diarrhea Palpitations and anxiety Nocturnal awakenings and blurred vision 1 points QUESTION 63 1. Jeremy is a 21-year-old male who is referred by his primary care provider. He has persistent erythema of both hands, which was initially thought to be eczema but eventually was diagnosed as a result of chronic, excessive handwashing. Further evaluation of Jeremy revealed findings consistent with obsessive compulsive disorder. The PMHNP considers that the most appropriate initial therapy for Jeremy would be: Clomipramine 25 mg daily Fluoxetine 40–80 mg daily Psychodynamic therapy Behavioral therapy 1 points QUESTION 64 1. Successful management of narcolepsy often involves combination treatment with both pharmacotherapy and a lifestyle regimen of regularly scheduled forced daytime naps. Which class of medications is used for its REM-suppressant properties in order to reduce cataplexy? Alpha-adrenergic receptor agonists Psychostimulants Tricyclic antidepressants Benzodiazepines 1 points QUESTION 65 1. Due to the adverse effect profile of second generation antipsychotics, patients taking them should have all the following monitored regularly except: Fasting blood sugar Body mass index Fractionated lipid panel Complete blood count Hyperorality and declining hygiene Abnormal focus on a single task or topic Psychosis and rapid mood changes Reduplicative paramnesia Contamination Pathological doubt Intrusive thoughts Symmetry A sleep deficit of 1–2 hours nightly for the last week Lack of symptoms related to attention, memory, or concentration Auxiliary symptoms of REM intrusion into the waking state History of sleep symptoms prior to this episode 1 points QUESTION 69 1. Stephen is a 19-year-old male who is having a court-mandated psychiatric assessment after causing a car accident that resulted in a serious, nonfatal injury to a passenger in his car. Stephen is adamant that he just “fell asleep” and he was not doing anything wrong. A review of his sleep history does not suggest a sleep deficit, although his mother says that he always “stays up late.” A careful history suggests that Stephen might be subject to narcolepsy attacks. Which of the following confirms a diagnosis of narcolepsy? Sleep-onset REM Excessive daytime sleepiness Cataplexy Hypnagogic hallucinations 1 points QUESTION 70 1. Which of the following is a true statement with respect to psychoanalytic therapy for patients with paraphilias? Best psychotherapeutic approaches remain consistent with Sigmund Freud’s theory Paraphilia as a conditioned response is the more contemporary conceptual framework of causation Cognitive-behavioral therapy has not demonstrated any success as a treatment modality Psychoanalytic therapy typically requires coincident external control to maximize success 1 points QUESTION 71 1. When considering biological issues in gender dysphoria, the PMHNP recognizes that: Sexual behavior in humans is governed primarily by sex steroids The resting state of mammalian tissue is initially male; estrogen is required to differentiate into females Masculinity, femininity, and gender identity in humans are due more to prenatal hormone distribution than postnatal life events Transgender people are more likely to be left handed The absent or deficient desire within the patient’s sociocultural context Whether or not the symptom is a source of distress to the patient The patient’s age and gender represent the population most affected The symptoms have been present for at least 6 months This probably represents difficulties in the relationship An underlying medical condition may be the cause The patient may respond well to pharmacotherapy A severe underlying psychopathology is likely Ziprasido ne Clozapin e Lorazepa m ECT Hypersomnia due to substance abuse Menstrual-related hypersomnia Hypersomnia due to medical condition Idiopathic hypersomnia Click Save and Submit to save and submit. 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