NUR631 Exam 3 -
neuro,musculoskeletal,mental health
A 19-year-old college student, Todd, is brought to your clinic by his mother. She is concerned
that there is something seriously wrong with him. She states for the past 6 months his behavior
has become peculiar and he has flunked out of college. Todd denies any recent illness or
injuries. His past medical history is remarkable only for a broken foot. His parents are both
healthy. He has a paternal uncle who had similar symptoms in college. The patient admits to
smoking cigarettes and drinking alcohol. He also admits to marijuana use but none in the last
week. He denies using any other substances. He denies any feelings of depression or anxiety.
While speaking with Todd and his mother you do a complete physical examination, which is
essentially normal. When you question him on how he is feeling, he says that he is very worried
that Microsoft has stolen his software for creating a better browser. He tells you he has se -
correct answer D) Schizophrenia
A 24-year-old secretary comes to your clinic, complaining of difficulty sleeping, severe
nightmares, and irritability. She states it all began 6 months ago when she went to a fast food
restaurant at midnight. While she was waiting in her car a man entered through the passenger
door and put a gun to her head. He had her drive to a remote area, where he took her money
and threatened to kill her. When the gun jammed he panicked and ran off. Ever since this
occurred the patient has been having these symptoms. She states she jumps at every noise and
refuses to drive at night. She states her anxiety has had such a marked influence on her job
performance she is afraid she will be fired. She denies any recent illnesses or injuries. Her past
medical history is unremarkable. On examination you find a nervous woman appearing her
stated age. Her physical examination is unremarkable. You recommend medication and
counseling.
What - correct answer C) Post-traumatic stress disorder
A 75-year-old homemaker brings her 76-year-old husband to your clinic. She states that 4
months ago he had a stroke and ever since she has been frustrated with his problems with
communication. They were at a restaurant after church one Sunday when he suddenly became
quiet. When she realized something was wrong he was taken to the hospital by EMS. He spent
2 weeks in the hospital with right-sided weakness and difficulty speaking. After hospitalization
he was in a rehab center, where he regained the ability to walk and most of the use of his right
hand. He also began to speak more, but she says that much of the time "he doesn't make any
sense." She gives an example that when she reminded him the car needed to be serviced he
told her "I will change the Kool-Aid out of the sink myself with the ludrip." She says that these
sayings are becoming frustrating. She wants you to tell her what is wrong and what you can do
about - correct answer A) Wernicke's aphasia
A 32-year-old white female comes to your clinic, complaining of overwhelming sadness. She
says for the past 2 months she has had crying episodes, difficulty sleeping, and problems with
,NUR631 Exam 3 -
neuro,musculoskeletal,mental health
overeating. She says she used to go out with her friends from work but now she just wants to
go home and be by herself. She also thinks that her work productivity has been dropping
because she just is too tired to care or concentrate. She denies any feelings of guilt or any
suicidal ideation. She states that she has never felt this way in the past. She denies any recent
illness or injuries. Her past medical history consists of an appendectomy when she was a
teenager; otherwise, she has been healthy. She is single and works as a clerk in a medical office.
She denies tobacco, alcohol, or illegal drug use. Her mother has high blood pressure and her
father has had a history of mental illness. On examination you see a woman appearing her st -
correct answer C) Major depressive episode
A 27-year-old woman is brought to your office by her mother. The mother tells you that her
daughter has been schizophrenic for the last 8 years and is starting to decompensate despite
medication. The patient states that she has been taking her antipsychotic and she is doing just
fine. Her mother retorts that her daughter has become quite paranoid. When asked why, the
mother gives an example about the mailman. She says that her daughter goes and gets the mail
every day and then microwaves the letters. The patient agrees that she does this but only
because she sees the mailman flipping through the envelopes and she knows he's putting
anthrax on the letters. Her mother turns to her and says, "He's only sorting the mail!"
Which best describes the patient's abnormality of perception?
A) Illusion
B) Hallucination
C) Fugue state - correct answer A) Illusion
A 22-year-old man is brought to your office by his father to discuss his son's mental health
disorder. The patient was diagnosed with schizophrenia 6 months ago and has been taking
medication since. The father states that his son's dose isn't high enough and you need to raise
it. He states that his son has been hearing things that don't exist. You ask the young man what
is going on and he tells you that his father is just jealous because his sister talks only to him. His
father turns to him and says, "Son, you know your sister died 2 years ago!" His son replies
"Well, she still talks to me in my head all the time!"
Which best describes this patient's abnormality of perception?
A) Illusion
B) Hallucination
C) Fugue state - correct answer B) Hallucination
, NUR631 Exam 3 -
neuro,musculoskeletal,mental health
A 26-year-old violinist comes to your clinic, complaining of anxiety. He is a first chair violinist in
the local symphony orchestra and has started having symptoms during performances, such as
sweating, shaking, and hyperventilating. It has gotten so bad that he has thought about giving
up his first chair status so he does not have to play the solo during one of the movements. He
says that he never has these symptoms during rehearsals or when he is practicing. He denies
having any of these symptoms at any other time. His past medical history is unremarkable. He
denies any tobacco use, drug use, or alcohol abuse. His parents are both healthy. On
examination you see a young man who appears worried. His vital signs and physical
examination are unremarkable.
What type of anxiety disorder best describes his situation?
A) Panic disorder
B) Specific phobia
C) Social phobia
D) Generalized anxiety disorder - correct answer C) Social phobia
A 23-year-old ticket agent is brought in by her husband because he is concerned about her
recent behavior. He states that for the last 2 weeks she has been completely out of control. He
says that she hasn't showered in days, stays awake most of the night cleaning their apartment,
and has run up over $1,000 on their credit cards. While he is talking, the patient interrupts him
frequently and declares this is all untrue and she has never been so happy and fulfilled in her
whole life. She speaks very quickly, changing the subject often. After a longer than normal
interview you find out she has had no recent illnesses or injuries. Her past medical history is
unremarkable. Both her parents are healthy but the husband has heard rumors about an aunt
with similar symptoms. She and her husband have no children. She smokes one pack of
cigarettes a day (although she has been chain-smoking in the last 2 weeks), drinks four to si -
correct answer B) Manic episode
A 72-year-old African-American male is brought to your clinic by his daughter for a follow-up
visit after his recent hospitalization. He had been admitted to the local hospital for speech
problems and weakness in his right arm and leg. On admission his MRI showed a small stroke.
The patient was in rehab for 1 month following his initial presentation. He is now walking with a
walker and has good use of his arm. His daughter complains, however, that everyone is still
having trouble communicating with the patient. You ask the patient how he thinks he is doing.
Although it is hard for you to make out his words you believe his answer is "well . . . fine . . .
doing . . . okay." His prior medical history involved high blood pressure and coronary artery
disease. He is a widower and retired handyman. He has three children who are healthy. He
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