NURS 6670 Psychiatric Mental Health

Nurse Practitioner Role II Adults &

Older Adults

Final Exam {75 Q & A}

1. Mrs. Johnson is a 79-year-old lady who has been managed for Alzheimer’s dementia

with a variety of nonpharmacologic management strategies such as promoting a clear

household routine, timed toileting, pet therapy, and other strategies to provide

structure. However, she was finally started on donepezil 10 mg daily at bedtime to try

and maximize cognitive function and memory. When following up for medication

tolerance and adverse effects, the PMHNP recognizes that the most common patient

complaints include:

A. Constipation and dry mouth

B. Nausea and diarrhea

C. Palpitations and anxiety

D. Nocturnal awakenings

2. Mr. and Mrs. Comstock are both patients of your practice; Mr. Comstock is treated for

depression, which is largely secondary to his wife’s progressive dementia. He is trying

to take care of her but finds it very emotionally difficult. Previously very active, they

have become socially isolated as their friends are not comfortable around Mrs.

Comstock’s progressively obvious dementia symptoms. Mr. Comstock’s brother and

his wife were visiting yesterday, and it became very uncomfortable. Mr. Comstock said

they were having a conversation about a recent election and his wife suddenly became

extremely agitated and started acting out inappropriately; she was yelling and broke a

figurine from the table; she finally left the room. He said this has not happened

before—that usually she participates in conversations, even if sometimes she jokes

too much or changes the subject. The PMHNP discusses with Mr. Comstock that it

sounds as though his wife:

A. Is depressed

B. Is demonstrating deterioration

C. Had a catastrophic reaction

D. Has an infection

3. 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 

4. Camille is a PMHNP student preparing a presentation for a group of primary care

providers on common signs and symptoms of psychiatric disorders often first seen in

primary care offices. The goal is to increase awareness of early indicators for mental

health referral. When discussing obsessive-compulsive disorder, Camille discusses that

the most common pattern of obsession is:

A. Contamination

B. Pathological doubt

C. Intrusive thoughts

D. Symmetry

5. All of the following strategies are used successfully to manage paradoxical insomnia

except:

A. Cognitive relabeling

B. Diffusing sleep worry

C. Anxiolytics

D. Changing environment

6. 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:

A. His religious delusions are of at least 4 weeks' duration and have produced

social or occupational impairment 

B. The delusions at some point, have occurred for 2 weeks absent a major mood

episode

C. Symptoms respond favorably to a combination of antipsychotic medications and

mood stabilizers

D. There is evidence of premorbid or prodromal symptoms prior to the psychotic

episode

Explanation: There was an uninterrupted duration of illness during which there is a

major mood episode (manic or depressive) in addition to criterion A for schizophrenia;

the major depressive episode must include depressed mood.

7. Nava is a 47-year-old female who has been in care for the last 9 months for a major

depressive episode. She has struggled with depression intermittently since her 20s,

but at this point she is on combination therapy with sertraline and bupropion and has

achieved an excellent remission. However, she is asking for some help with her sleep.

She says she has always had insomnia to some degree, mostly trouble falling asleep,

but she thought that once she felt better from her depression it would improve. A

review of Nava’s sleep hygiene habits reveals that there are numerous areas that

could benefit from improvement. Nava’s sleep hygiene habits should ultimately be

improved to include all the following except:

A. Maintaining a regular exercise schedule

B. Reading a book in bed with no distractors

C. Having a light snack at bedtime if hungry

D. Ensuring that the bedroom is cool

8. 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:

A. Cerebellum