NURS 6670 FINAL EXAM Q & A
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
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
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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Pages | 40 |
Language | English |
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