NURS 6670 / NURS6670 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

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 exboyfriend 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. 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 against

them and hallucinations are false perceptions, such as

listening, or feeling something that does not exist.

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 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:

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 a

result 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 taking

medications. While 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, often

at inopportune times.

Question 6.

The PMHNP is asked to prepare a presentation for nonnursing 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?

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 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?

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 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 Kleine-Levin syndrome

and further assesses for coincident onset of:

Hypersexuality

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