NU664 Primary Care of the Psychiatric Mental Health Client I
Week 15 Final Exam
Question 1A 16 y/o girl is brought to your office for an initial consultation. Since her parent's divorce three months ago, she has been irritable and has had problems keeping up her grades in school. She spends most of the time at home and does not want to engage in social activities. She denies any change in her appetite or weight, reports being able to sleep well, and denies any feelings of helplessness or hopelessness. What would be the best initial treatment of this patient?
Select one:
a.A trial of citalopram
b.Supportive psychotherapy
c.Long-term psychodynamic psychotherapy
d.Inpatient admission to an inpatient adolescent unit
Question 2A 22 y/o woman is referred to your office by her family physician for an evaluation of her "depression." Her PCP is unsure whether she is suffering from depression or something else. Which of the following characteristics is more consistent with a persistent depressive disorder (dysthymia) versus major depression?
Select one:
a.Episodic course
b.Numerous neurovegetative symptoms
c.Presence of psychotic symptoms
d.Symptoms that are lower in intensity and chronic in nature
e.Severe impairment in functioning
Question 3A 40 y/o woman with bipolar disorder presents to your office after starting a new medication. She reports that she was doing "well" until she got a viral gastroenteritis and was unable to eat for several days. While the viral symptoms have resolved, she now complains of nausea and vomiting, ataxia, and tremor. Which of the following studies would you order?
Select one:
a.Carbamazepine level
b.Depakote level
c.Head CT
d.Lithium level
e.Urine toxicology screen
Question 4 A 46 y/o man presents with a long-standing belief that his thoughts are being taken from his head and used to create a blockbuster movie. He is certain that the government is involved because they often communicate with him through a microchip they have implanted in his brain. What would this most likely diagnosis be for this gentleman?
Select one:
a.Major depression with psychotic features
b.Schizoaffective disorder
c.Schizophrenia
d. Psychosis secondary to a general medical condition
e.Bipolar disorder I with psychotic features
Question 5A 70 y/o woman presents to her PCP complaining of fatigue for the past seven weeks. She admits to difficulty falling asleep, a poor appetite with a 10-lb. weight loss, and thoughts of wanting to die. She admits to having had symptoms similar to these on several occasions in the past, but "never this bad." Her medical problems include asthma and HTN. She uses an albuterol inhaler only as needed. Which of the following symptoms is additionally necessary in order to make a diagnosis of major depressive disorder?
Select one:
a.Depressed mood
b.Decreased appetite
c.Excessive guilt
d.Fatigue
e.Homicidal ideation
Question 6A child who is indifferent toward its caregiver and is just as easily comforted by a stranger as by a parent may be assessed as having which attachment style?
Select one:
a.Secure
b.Avoidant
c.Disorganized
d.Ambivalent
Question 7A client says to the PMHNP, "Some days life is just not worth it. All I do is argue with my boss, fight with my wife, and yell at my kids. Things would be a lot calmer and simpler if I just wasn't around anymore." The most therapeutic response for the PMHNP to make is ________.
Select one:
a."Do you mean you want to kill yourself?"
b."Are you thinking about leaving your wife and quitting your job?"
c.to remain silent and let the client continue
d."Tell me what you mean when you say it would be simpler if you weren't around."
Question 8A new client has the following symptoms: Has had insomnia for five days, sees "devils" walking across the room, cannot recall when she last ate, carries a large notebook with numerous unusual drawings and lists of project that are "in the works," and has drawn abstract pictures in ink on her forearms and clothing. The client is most likely diagnosed with ________.
Select one:
a.Cyclothymia
b.Substance-induced anxiety disorder
c.Dysthymia
d.Schizoaffective disorder, depressive subtype
e.Bipolar I with psychotic features
Question 9A PMHNP is using a cognitive-behavioral approach to help an adolescent client change self-defeating behaviors. Which of the following would a PMHNP highlight when using CBT?
Select one:
a.Feelings
b.Introjection
c.Beliefs
d.Transference
Question 10According to American Diabetes Association recommendations, how frequently should fasting plasma glucose/HbA1C and fasting lipid profile be monitored in patients treated with antipsychotic agents?
Select one:
a.Every 6 weeks
b.Annually
c.Baseline, 12 weeks, then annually
d.Every 2 years
Question 11According to the DSM, which of the following would you find when doing a history on a client with a diagnosis of bipolar disorder type II who is currently in a depressive episode?
Select one:
a.History of prior manic episodes
b.Far more manic episodes than depressive episodes
c.No known history of hypomanic or manic episodes
d.Prior hypomanic episodes without prior manic episodes
Question 12Among the different types of temperament, which one is associated with more impairment of brain functioning, and in the absence of positive nurturing parenting, is a risk factor for later development of psychiatric disorders?
Select one:
a.Easy
b.Slow to warm up/inhibited
c.Mixed
d.Difficult
Question 13Antonio is an 18 y/o single male who recently dropped out of his first semester of college. He says he could not continue in his courses because he was feeling uncomfortable in class and was receiving failing grades. Prior to this, he relays symptoms including anxiety, excessive worrying, trouble relaxing, irritability, and difficulty sleeping. He says he worries about "everything," especially his health, finances, his future, and the health of his family. The PMHNP diagnoses Antonio with ________.
Select one:
a.generalized anxiety disorder
b.somatic symptom disorder
c.attention deficit hyperactivity disorder
d.illness anxiety disorder
Question 14Assessing resiliency is a part of the overall mental health evaluation process. Resiliency could be defined as ________. "
Select one:
a.adaptability
b.resourcefulness
c.self-efficacy
d.the ability to bounce back from negative life experiences
e.All these answers are correct.
Question 15Current Procedural Terminology (CPT) is a code set by the American Medical Association. Its function is to ________.
Select one:
a.describe medical, surgical, and diagnostic services
b.communicate uniform information about medical services
c.describe services for billing purposes
d.All of these answers
Question 16Cyclothymia is different from Bipolar I and II in that the patient needs to experience symptoms for at least ________ with numerous hypomanic and depressive episodes that do not meet criteria for hypomania or depression.
Select one:
a.one year
b.two years
c.three years
d.6 months
e.18 months
Question 17In the biopsychosocial theory of the development of psychiatric disorders, it is proposed that psychiatric disorders are due to a combination of ________.
Select one:
a.exposure to adverse experiences and a large social support network
b.compromised brain development and adverse experiences
c.small family size and challenging learning experiences
d.democratic parenting style and limited financial resources
Question 18Leonard avoids going out to eat with his family at restaurants. He is concerned that others may watch him and criticize his table manners. He also has difficulty going to grocery stores and public swimming pools. Which of the following is his most likely diagnosis?
Select one:
a.Agoraphobia
b.Specific situational phobia
c.Social anxiety disorder
d.Generalized anxiety disorder
Question 19Part of the diagnostic criteria for bipolar disorder must include which of the following?
Select one:
a.A persistently elevated, expansive, or irritable mood lasting for at least 1 month
b.A persistently elevated, expansive, or irritable mood lasting for at least 1 week
c.A persistently elevated, expansive, or irritable mood lasting for at least 2 weeks
d.A persistently elevated, expansive, or irritable mood lasting for at least 6 months
Question 20A term used to explain a confused or unintelligible mixture of seemingly random words and phrases is ________.
Select one:
a.flight of ideas
b.word salad
c.tangentiality
d.circumstantiality
e.looseness of association
Question 21People with recurrent panic disorder usually present with ________.
Select one:
a.a low level of general anxiety
b.cardiac/respiratory symptoms of distress
c.la belle indifference
d.clear precipitants
Question 22People whose affect development has proceeded optimally are more aware and less emotionally reactive. Which statement about people who have problems with affective regulation is true?
Select one:
a.They have a great deal of trouble describing their feelings.
b.They lack self-awareness.
c.They have poor body awareness of emotional arousal.
d.All of these answers
Question 23Pharmacotherapy for manic episodes or mixed episodes in the acute phase includes ________.
Select one:
a.mood stabilizers
b.antipsychotics
c.benzodiazepines
d.All these answers are correct.
Question 24Solution-Focused Brief Therapy (SFBT) is a treatment approach that focuses on both the present and future. Which statement best describes this approach?
Select one:
a.It is a conversation that is directed at developing and achieving the client's vision of solutions.
b.The solution is almost always related to the problem.
c.It is a way to develop clear, concrete, and nonspecific goals with the client.
d.It is a creative approach that includes music and art as the therapy.
Question 25Symptoms of anxiety and panic are associated with a low level of which neurotransmitter?
Select one:
a.Cortisol
b.Dopamine
c.Norephinephrine
d.Gamma-aminobutyric acid
e.Glutamate
Question 26The essential differences between mania and hypomania are duration of time and severity of symptoms. Which of the following statements reveals this distinction between the two diagnoses?
Select one:
a.In hypomania, an elevated, expansive, or irritable mood lasts for at least four days and there is not marked impairment in social or occupational functioning.
b.In hypomania, an elevated, expansive, or irritable mood lasts for at least three days and leads to marked impairment in social or occupational functioning.
c.In hypomania, an elevated, expansive, or irritable mood lasts for at least four days and leads to marked impairment in social and occupational functioning.
d.In hypomania, an elevated, expansive, or irritable mood lasts for at least seven days but does not lead to marked impairment in social or occupational functioning.
Question 27The Id, Ego, and Superego _________.
Select one:
a.are the three primary psychic structures that make up the mind
b.are responsible for mental functioning
c.commonly come in conflict over what to do to achieve gratification
d.None of these answers
e.All of these answers
Question 28The purpose of the American Nurses Association's Scope and Standards of Psychiatric-Mental Health Clinical Nursing Practice is to ______.
Select one:
a.define the role and action for the NP
b.establish the legal authority for the prescription of psychotropic medications
c.define the legal authority of the PMHNP
d.define the differences between the physician role and the NP role
Question 29The role of neurotransmitters in the central nervous system is to function as ________.
Select one:
a.a communication medium
b.a gatekeeper for transmissions
c.a building block for amino acids
d.an agent to break down enzymes
Question 30Which of the following definitions of statutory law is correct?
Select one:
a.Statutory law outlines the rules and regulations for each state and may provide restrictions in practice unique to a specific state.
b.Statutory law is a process by which an agency of state government grants permission to individuals accountable for the practice of a profession.
c.Statutory law protects the public by ensuring a minimal level of professional competence.
d.Statutory law is a process that provides title protection.
Question 31A patient who has just been started on Haldol 5 mg po bid is complaining of a sudden painful stiff neck and jaw muscles. This is most likely ________.
Select one:
a.akinesia
b.akathisia
c.dystonia
d.somatization
Question 32Which of the following is closely related to poor functional outcomes in patients with schizophrenia?
Select one:
a.Hallucinations, distorted perceptions, and/or paranoid delusions
b.Negative symptoms
c.Disorganized clinical symptoms
d.Cognitive impairment
Question 33Which of the following statements best describes the nurse-client relationship?
Select one:
a.The primary focus is on the nurse's need to gather information about the client.
b.Goals in the nurse-client relationship are intentionally left vague until the relationship is better established.
c.In the nurse-client relationship, the responsibility lies squarely on the shoulders of the nurse to reach out and make a connection.
d.There is no place for social interactions between the client and the nurse.
e.The primary focus is on the client and his/her needs.
Question 34Which of these brain structures puts emotional meaning on a stimulus, forms emotional memories, and is involved with rage and fear?
Select one:
a.Hippocampus
b.Basal ganglia
c.Amygdala
d.Midbrain
Question 35Which structure in the brain is responsible for temperature regulation, thirst, appetite, endocrine control, and sleep and wakefulness?
Select one:
a.Basal ganglia
b.Amygdala
c.Thalamus
d.Hypothalamus
e.Hippocampus
Question 36Who is generally credited with developing dialectical behavioral therapy?
Select one:
a.Melanie Klein
b.Aaron Beck
c.B.F. Skinner
d.Marsha Linehan
e.Harry Stack Sullivan
Question 37Each state has its own Board of Registration for Nursing, but the federal agency NONPF regulates the practice of PMHNPs.
Select one:
True
False
Question 38A 32 y/o woman is brought to the ED by police after she was found standing in the middle of a busy highway, naked, commanding the traffic to stop. In the ED, she is agitated and restless, with pressured speech and an affect that alternates between euphoric and irritable. Her father is contacted and states that this kind of behavior runs in the family. Which of the following is the most likely diagnosis?
Select one:
a.Dementia
b.Hypothyroidism
c.Bipolar disorder type I, manic
d.Cyclothymia with psychosis
e.Schizophrenia
Question 39During group therapy, a client asks the PMHNP group leader for advice on how to handle the stress of her new job. The best approach for the leader is to ________.
Select one:
a.answer her question directly
b.enlist the other group members to respond
c.encourage the client to speak to her after the group
d.use silence
Question 40A 17 y/o girl with a history of asthma presents to her FNP for a physical exam prior to going to college. Upon questioning, the FNP learns that she has felt irritable for the past six months since breaking up with her boyfriend of two years. She says she feels tired all the time and comes home from school every day, lies on the couch, and watches TV. Her grades have dropped because she cannot concentrate. Despite her fatigue, she complains of difficulty sleeping. She has lost 12 lbs. over the past six months. She no longer hangs out with her friends, has dropped some of her after-school activities and is considering not even going to college since she can't imagine things will ever get better. Her H&P is normal. Which of the following symptoms of depression in this patient differs from that of an adult?
Select one:
a.Anhedonia
b.Decreased concentration
c.Insomnia
d.Irritable mood
Question 41A 32 y/o woman presents to her PCP with the chief complaint that she is anxious about the way she looks. She notes that for as long as she can remember, she has felt there is something wrong with her face. She thinks her eyes are too far apart and that her nose is misshapen. She states that this concern is ruining her life because she spends all her time isolated from others so that they cannot see her face. There does not seem to be anything unusual about her appearance. Even when her PCP gives her positive feedback, she is not convinced it is true. Which of the following is the most likely diagnosis?
Select one:
a.Delusional disorder
b.Obsessive-compulsive disorder
c.Body dysmorphic disorder
d.Somatization disorder
e.Anxiety disorder
Question 42A 37 y/o man with a diagnosis of schizoaffective disorder develops an alteration in his level of consciousness, marked muscle rigidity, mild fever, hypertension, leukocytosis, and an elevated CPK. He has been transferred to the ICU and is being treated for acute renal failure. A recent change in which medication is most likely responsible for this presentation?
Select one:
a.Lithium
b.Citalopram
c.Fluphenazine (Prolixin)
d.Clonazepam
e.Benztropine
Question 43A 44 y/o man comes to see you complaining of insomnia and poor concentration since he was fired from his job a few weeks ago. He reports being hopeful that he will find a new job soon and has sought out the support of his family and friends. However, he has found it difficult to pursue some of his regular daily activities, such as going to the gym. He has also noticed that he feels very tired during the day, which he attributes to poor sleep. Given this history, what is this patient's most likely diagnosis?
Select one:
a.Acute stress disorder
b.Major depressive disorder
c.Dysthymia
d.Cyclothymia
e.Adjustment disorder
Question 44A patient who has been taking venlafaxine for major depressive disorder says that recently he has not be able to sleep and he spends increasing amounts of time writing letters to his congressman about ways to reduce the national debt. The PMHNP is concerned about this change and feels the most likely explanation for the change in this man's clinical picture is ________.
Select one:
a.non-compliance with medication
b.worsening depression with psychotic features
c.emergence of hypomania
d.probable substance-use issues
Question 45A PMHNP screens his client by asking questions on the CAGE questionnaire. This is an example of ________ prevention.
Select one:
a.primary
b.secondary
c.tertiary
d.None of these answers
Question 46A subtype of OCD that begins before puberty and is characterized by an episodic course with severe exacerbations has been linked to infections caused by ________.
Select one:
a.C. difficile
b.Group A beta-hemolytic strep infection
c.Group B beta-hemolytic strep infection
d.enterovirus
Question 47Brain plasticity, which refers to the brain's capacity to change in response to an event, ________.
Select one:
a.is the same for all individuals
b.involves physical changes in the brain
c.is absent in older adults
d.is independent of genetic influence
e.is a concept not well received by scientists
Question 48Developing differentials is an essential part of the assessment and diagnostic process. A stepwise approach is especially important when you are looking at organic "rule-outs." Which statement best describes why this process is so difficult?
Select one:
a.Symptoms of a psychiatric and medical disorder are rarely identical.
b.Some presenting symptoms of medical illnesses are psychiatric in nature.
c.Medical providers rarely dismiss the medical concerns of a known psychiatric client.
d.None of these answers
