NURS 6670 / NURS 6670N FINAL EXAM.

QUESTIONS AND ANSWERS WITH EXPLANATIONS.

Question1.

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 motherreports 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 thather

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-boyfriendhad 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 exboyfriend to get her fired. After this morning's

incident, her mother was so worriedshe 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

againsther. Head imaging, screening lab, and a

toxicology screen are negative. A leading differential

for Collette is:

Acute psychotic episode

Rationale:

Collette's differential diagnosis is an acute psychotic

episode,this disorder causes abnormal ideas and

perceptions. Two of the main symptoms are delusions

and hallucinations.

Delusions are false beliefs, such as that someone is

againstthem and hallucinations are false perceptions,

such as listening, or feeling something that does not

exist.

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Question 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 ofintense

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:

Are often associated with trauma or psychiatric problems

Question 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 aresult of:

Increased dopamine activity in the mesolimbic pathway

Question 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 takingmedications. While

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following Johanne, the PMHNP should be alert to

signs and symptoms of

Depression

Question 5.

Narcolepsy

A sleep disorder characterized by uncontrollable sleep

attacks. The sufferer may lapse directly into REM

sleep, oftenat inopportune times.

Question 6.

The PMHNP is asked to prepare a presentation for

non- nursing health care workers in a local longterm 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 tobe reported to

the patient's attending provider right away. The

case should emphasizewhich of the following

features as being closely correlatedwith delirium?

Rapid onset

Question 7.

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 nightof repeatedly checking

every door and window in the home to ensure that they

were locked.

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Valerie's nighttime routine is exhaustive and involves

checking every door and window at least four times.

She hasa remote history of being attacked in her home

while alone and states that she is unable to go to bed

until she is certainthat every door and window is

locked. When considering diagnostic criteria for OCD,

the PMHNP needs further assessment to ascertain

which diagnostic criteria?

The patient has good or fair insight with respect to the

appropriateness of her behaviors

Question 8.

Michael is an 18-year-old male who is presented to care

at theurging 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 dangerof 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 Kleine-Levin

syndromeand further assesses for coincident onset of:

Hypersexuality

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