NURS 6670 FINAL EXAM Q & A

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QUESTION 1

1. Collette is a 23-year-old female who presented for emergency care with her mother

because her behavior has become increasingly erratic and caused her to lose her job.

Her mother reports that she had never done anything like this in the past, but about 3

months ago, her boyfriend of 3 years broke up with her, and Collette began to express

unrealistic beliefs that her boyfriend wanted to drive her crazy and hurt her. A

gentleman trying to hail a taxi accidentally bumped into her this morning, and she

started screaming that her ex-boyfriend had hired the man to throw her into the

street under a car. Collette is on a 2-week suspension from her job as a restaurant

server because she was combative to a customer—she accused him of colluding with

her ex-boyfriend to get her fired. After this morning’s incident, her mother was so

worried she brought her to the emergency room. Her appearance is disheveled, she is

clearly hyperalert and is crying that her boyfriend must have converted her mother to

work against her. Her imaging, screening lab, and a toxicology screen are negative. A

leading differential for Collette is:

A. Bipolar disorder

B. Acute psychotic episode

C. Schizophreniform disorder

D. Post-traumatic stress disorder

QUESTION 2

2. 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:

A. Are often associated with trauma or psychiatric problems

B. Represent a disorder of REM sleep

C. May be a symptom of temporal lobe epilepsy

D. Is treated with a cycle of sleep deprivation

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QUESTION 3

3. Jack is a 27-year-old male who has a history of paranoid schizophrenia that first

became apparent approximately 10 years ago. He developed paranoid delusions and

eventually decompensated to the point that he required inpatient stabilization. At the

time, he was started on conventional antipsychotics, but due to intolerable adverse

effects he was switched to haloperidol. It worked well, but whenever he stopped

taking it, symptoms would recur. After several hospitalizations, he was stabilized. The

neurophysiologic theory of schizophrenia suggests that Jack’s symptoms were a result

of

A. Increased dopamine activity in the mesolimbic pathway

B. Increased dopamine activity in the mesocortical pathway

C. Increased glutamate in the prefrontal cortex

D. Increased glutamate in the hippocampus

QUESTION 4

4. Johanne is a 22-year-old female who is being treated for narcolepsy. She is attempting

to implement a regimen of forced daytime naps in an effort to manage her condition

without pharmacotherapy as she is generally averse to taking medications. While

following Johanne, the PMHNP should be alert to signs and symptoms of:

A. Suicidality

B. Depression

C. Hyperphagia

D. Disinhibition

QUESTION 5

5. The PMHNP is asked to prepare a presentation for non-nursing health care workers in

a local long-term care facility on the various causes of cognitive impairment in the

elderly. A case presentation approach is used to reinforce principles of identifying

delirium, which needs to be reported to the patient’s attending provider right away.

The case should emphasize which of the following features as being closely correlated

with delirium?

A. Perceptual disturbances

B. Rapid onset

C. Agitation

D. Abnormal sleep patterns

QUESTION 6

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6. Valerie is a 27-year-old woman who has been referred by her primary care provider.

She was initially diagnosed with major depressive episode following a breakup with

her boyfriend of 7 years. They moved into a house together 1 year ago, but within a

few months the boyfriend moved out. Valerie was unresponsive to medication for

depression and was referred to the mental health clinic. During this initial psychiatric

evaluation, the PMHNP learns that a primary reason for the breakup was that Valerie

had an extensive routine every night of repeatedly checking every door and window

in the home to ensure that they were locked. Valerie’s nighttime routine is exhaustive

and involves checking every door and window at least four times. She has a remote

history of being attacked in her home while alone and states that she is unable to go

to bed until she is certain that every door and window is locked. When considering

diagnostic criteria for OCD, the PMHNP needs further assessment to ascertain which

diagnostic criteria?

A. The patient has tried unsuccessfully to suppress the urge to repeatedly check locks

B. The compulsive activities are time-consuming to the extent that at least 1 hour

daily is spent on them

C. The disturbance is not better explained as the symptoms of another mental

disorder

D. The patient has good or fair insight with respect to the appropriateness of

her behaviors

QUESTION 7

7. Michael is an 18-year-old male who is presented to care at the urging of his parents.

He has never had any significant medical or psychiatric problems in the past, but

during his first semester at college he has developed a very alarming pattern of excess

sleep. He is missing classes and is in danger of losing a scholarship. He is sleeping

normally at night but apparently is having these very long episodes of napping and

sleeping during the day. When he is awake, he tends to be rather withdrawn. His

parents have taken him to their family practitioner as they thought he might be using

drugs. A full exam, laboratory assessment, and toxicology screen are all normal, and

there is no apparent cause for this sleepiness. While very rare, the PMHNP considers

Kleiner-Levin syndrome and further assesses for coincident onset of:

A. Narcolepsy

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