NU664C 2022 May Week 15 Quiz Latest

NU664C 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?

 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?

 a.pisodic 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?

 a.Carbamazepine level

 b.Depakote level

 c.Head CT

 d.Lithium level

e.Urine toxicology screen

Question 4A 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?

 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

The  answer is: Schizophrenia

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?

 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?

 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 ________.

 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 ________.

 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?

 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?

 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?

 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?

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 ________.

 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 ________. “

 a.adaptability

 b.resourcefulness

 c.self-efficacy

 d.the ability to bounce back from negative life experiences

 e.All these answers are .

Question 15Current Procedural Terminology (CPT) is a code set by the American Medical Association. Its function is to ________.

 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.

 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 ________.

 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?

 

 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?

 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 ________.

 a.flight of ideas

 b.word salad

c.tangentiality

 d.circumstantiality

 e.looseness of association

Question 21People with recurrent panic disorder usually present with ________.

 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?

 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 ________.

 a.mood stabilizers

 b.antipsychotics

 c.benzodiazepines

 d.All these answers are .

Question 36Who is generally credited with developing dialectical behavioral therapy?

 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 tration for Nursing, but the federal agency NONPF regulates the practice of PMHNPs.

  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?

 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 ________.

 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?

 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

, she is not convinced it is true. Which of the following is the most likely diagnosis?

 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?

 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?

 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 ________.

 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.

 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 ________.

 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, ________.

 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?

 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

 

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