Psychiatric Disorders and Treatments, Exams of Nursing

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Conrad, a 26-year-old male, is being treated for cuts after being arrested for breaking the windows in the home of his girlfriend, who has just told him that they are through. He has a history of having been physically abused by his father, setting fires as a child, treatment for substance abuse, and arrest for stealing a car. Which of the following personality disorders might the clinician consider? Question 1 options:a) Narcissistic b) Paranoid c) Antisocial d) Histrionic - ANSWER Antisocial In a biopsychosocial case formulation, social contributions would be considered to be: a) Genetic influences and adverse circumstances of birth b) Substance use and medical disorders c) Cognitive deficits and dysregulation of emotions d) Religious/cultural factors and living situations - ANSWER Religious/cultural factors and living situations

Which of the following criteria would preclude the use of brief dynamic therapy? a) Adequate ego strengths b) Psychological problems in multiple domains c) Use of mature defense mechanisms d) Adequate ability to process information - ANSWER Use of mature defense mechanisms In treatment of the acute phase of mania, the focus is on:a) Protecting the patient's biopsychosocial safety b) Educating the patient about social rhythms theory c) Interventions that address impairment of vocational functioning d) Interventions for self-management of finance - ANSWER Protecting the patient's biopsychosocial safety During an initial assessment, the relevant features of communication are its ability to: a) Promote a therapeutic alliance and increase understanding. b) Prompt a disclosure of past successes and failures. c) Bring about changes in behavior.

d) Educate the patient about what is important to disclose. - ANSWER Symptoms of anxiety and panic are associated with a low level of which neurotransmitter? a) Cortis ol b) Dopamine c) Gamma-aminobutyric acid d) Glutamate - ANSWER Gamma-aminobutyric acid Which class of antidepressants has the most anticholinergic side effects? a) Monoamine oxidase inhibitors (MAOIs) b) Selective serotonin reuptake inhibitors (SSRIs) c) Tricyclic antidepressants (TCAs) d) Serotonin norepinephrine reuptake inhibitors (SNRIs) - ANSWER Tricyclic antidepressants (TCAs) A 16-year-old male patient is hospitalized for depression after attempting suicide by overdose. Several days later, the patient reports feeling less depressed and having fewer suicidal thoughts, but begins to threaten suicide "if things do not work out." Nursing staff members report feeling resentful and manipulated, but fear for the patient's safety. The adult psychiatric and mental health nurse practitioner's intervention is to a)

:assist the staff in developing a treatment plan that limits contact with the patient to one person per shift. b) develop a "no suicide" pact with the patient to decrease his helplessness and increase his feelings of control. c) encourage the patient to express his fears of improving and being abandoned or of leaving the safe environment. d) increase supervision and restrict milieu participation to decrease the secondary gain from manipulation. - ANSWER encourage the patient to express his fears of improving and being abandoned or of leaving the safe environment. A female client complains of an intense, overwhelming fear of driving a car. The fear has disrupted all elements of her life. She does not go to the grocery store unless someone transports her, has relinquished her job, and has few social contacts. Her treatment plan include s: assertiveness training. b) biofeedback. c) stress management assistance. d) systematic desensitization. - ANSWER A patient with borderline personality disorder experiences intense anxiety when an adult psychiatric and mental health nurse practitioner goes on vacation. The best explanation

for this reaction is that the patient: - ANSWER has failed to develop clear ego boundaries. b) has failed to master object constancy. c) is employing primitive idealization. d) is employing projective identification. An outpatient mental health clinic-based adult psychiatric and mental health nurse practitioner treats a 32-year-old patient who has diabetes and a major depressive disorder. The patient reports an improved and stable mood on a trial of duloxetine (Cymbalta), but experiences continued neuropathic pain. The nurse practitioner's initial intervention is to: - ANSWER add gabapentin (Neurontin) to the treatment regimen. b) conduct additional diagnostic tests. c) contact the patient's endocrinologist. d) increase the dosage of duloxetine (Cymbalta). Among the following statements, which best describes the action of older typical antipsychotic medications such as Haldol? - ANSWER They block dopamine receptors in all four dopamine pathways. b) They decrease available amounts of serotonin and norepinephrine. c) They decrease the metabolism of dopamine in the synaptic cleft. d)

They selectively block reuptake of dopamine. Which of the following structures provides for communication between the two hemispheres of the brain? - ANSWER ) Lateral ventricle b) Basal ganglia c) Corpus callosum d) Hypothalamus On evaluation, the patient appears to be having difficulty with working memory, planning, and insight into his problems. The psychiatric advanced practice nurse recognizes that these symptoms are associated with problems with the:) Frontal lobe b) Temporal lobe c) Parietal lobe d) Occipital lobe - ANSWER Frontal lobe n cognitive therapy, therapists focuses on patients':a) Use of immature defense mechanisms b) Learned behavior of helplessness c)

Automatic negative thoughts d) Attachment patterns - ANSWER Automatic negative thoughts With regard to the biological markers for schizotypal personality disorder, all of the following have been reported except: a) Increased ventricles b) Increased cerebrospinal fluid c) Impaired smooth pursuit eye movements d) Impaired of executive functioning - ANSWER Impaired of executive functioning Serving as a member on a crisis team, an adult psychiatric and mental health nurse practitioner provides crisis intervention to the survivors of a plane crash. Forty-eight hours after the accident, the survivors describe vivid flashbacks, startle reactions, and disrupted sleep patterns. The nurse practitioner responds by: a) advising the survivors to consider using a hypnotic medication for a brief period. b) educating the survivors about prodromal symptoms of posttraumatic stress disorder. c) encouraging the survivors to rest during the day. d) suggesting that the survivors join a posttrauma support group. - ANSWER educating the survivors about prodromal symptoms of posttraumatic stress disorder.

When lobbying a local congressional representative to include nurse practitioners in reimbursement for services in all areas of the country, an adult psychiatric and mental health nurse practitioner emphasizes the: ability of nurse practitioners to provide health care that patients need. b) fact that nurse practitioners are caring in their patient care delivery. c) importance of broadening the scope of nursing practice. d) necessity of offering equivalent services both to urban and rural patients - ANSWER .ability of nurse practitioners to provide health care that patients need. The primary function of a biopsychosocial case formulation is to: a) Generate an understanding of the person as a whole b) Identify comorbid medical illnesses c) Assess the maturity of the patient's defense mechanisms d) Determine patient's level of social support - ANSWER Generate an understanding of the person as a whole Which behavior reflects existentially oriented therapy? a) Attempting to understand a patient's subjective world b) Challenging a patient's irrational beliefs

c) Developing specific plans for change d) Establishing general group goals - ANSWER Attempting to understand a patient's subjective world When a research study is based on a small sample size, the findings may: - ANSWER be statistically significant, but will be less generalizable than if the sample size had been larger. b) be statistically significant, but will not be clinically significant. c) not be statistically significant, because the research design was quasi- experimental instead of experimental. d) not be statistically significant, because the research was poorly conducted. Brain plasticity, which refers to the brain's capacity to change in response to an event,: - ANSWER ) Is the same for all individuals b) Involves physical changes of the brain c) Is absent in older adults d) Is independent of genetic influence

A 23-year-old female patient with borderline personality disorder reports a frequent desire to cut herself and insists that only a specific psychiatric and mental health nurse can help her. The nursing care plan for the patient includes: - ANSWER a) allowing her to choose the nurse assigned to her. b) decreasing stimuli. c) holding frequent interdisciplinary staff meetings to provide consistent care. d) providing one-to-one suicide precautions. The older typical antipsychotic medications would be expected to be most effective for which of the following target symptoms? - ANSWER Social isolation b) Apathy c) Hallucinations d) Lack of motivation A young adult who works as a court reporter describes herself as being depressed most of the time and says she has been that way since her teens. She denies any weight loss or sleep disturbances. She describes problems with concentration, difficulty making decisions, and lack of energy that are causing her problems at work. Which of the following is the most likely diagnosis? - ANSWER a) Dysthymia b) Major depressive disorder with seasonal pattern c)

Major depressive disorder with atypical features d) Major depressive disorder with melancholic features The principal excitatory neurotransmitter in the central nervous system is: - ANSWER a) Gamma-aminobuytric acid (GABA) b) Serotonin c) Glutamate d) Acetylcholine The neurotransmitters most widely accepted to be dysregulated in delirium are: - ANSWER a) Norepinephrine and acetylcholine b) Norepinephrine and serotonin c) Serotonin and acetylcholine d) Dopamine and acetylcholine The process of allostasis includes: - ANSWER Mobilization of energy, activation of cognition, and behavioral changes b) Reduction of production of cortisol c)

Decreased levels of norepinephrine d) Development of a state of exhaustion Patients' perceptual difficulties may have an adverse effect on the therapeutic alliance. Which of the following is likely to have the greatest negative effect? - ANSWER The patient perceives the office seating arrangement as belittling. b) The patient perceives the clinician as being part of her delusional system. c) The patient perceives the sound in the hall as messages for the patient. d) The patient perceives the clinician's glancing at his watch as nonvalidating. A short-term goal for a patient with Alzheimer disease is: - ANSWER ) improved problem-solving in activities of daily living. b) increased self-esteem and improved self-concept. c) optimum functioning in the least restrictive environment. d) regained sensory perception and cognitive function. Narcissistic personality disorder is more likely to occur in families that: - ANSWER Teach children to put family and community ahead of personal desires. b) Encourage children to develop problem-solving skills. c)

Teach children that they are special and entitled to the best in life. d) Encourage resilience in the face of adversity. The function of this brain structure was formerly believed to be limited to maintaining balance and learning motor skills but is now believed to be involved in learning and emotions and may be involved in autism. It is the: - ANSWER ) Cerebellum b) Insula c) Corpus callosum d) Pons The core principle of relational therapies that include psychodynamic psychotherapy and interpersonal psychotherapy is that current problems reflect: - ANSWER a) Learned behavioral responses b) Failure to integrate life experiences c) Problems with relationships with others d) Distorted perceptions of ability to cope An adult psychiatric and mental health nurse practitioner uses a cognitive- behavioral approach to help an adolescent patient change self-defeating behaviors. After identifying the initial stressor that is causing the inappropriate behavior, the therapeutic intervention is to identify:

Question 34 options: a) alternative positive responses to the stressor. b) negative consequences of the behavioral response to the stressor. c) possible outcomes of alternative responses. d) rational and irrational beliefs about the stressor. - ANSWER In GAD, which of the following is true? Question 35 options: a) GAD is rare in older adults. b) Worrying may be associated with the belief that it keeps the family safe. c) Worrying is usually limited to one type of worry, such as locking doors. d) Worrying is usually accompanied by ritualistic behaviors. - ANSWER Which of these brain structures puts emotional meaning on a stimulus, forms emotional memories, and is involved with rage and fear? Question 36 options: a) Hippocampus b)

Temporal lobe c) Amygdala d) Midbrain - ANSWER A psychiatric and mental health nurse verbally reviews medication information with an adolescent male patient and provides him with several handouts. The patient listens intently, nods, ignores the handouts, and states that he fully understands the information. The nurse further assesses for: Question 37 options: a) attentional deficits. b) level of intelligence. c) literacy. d) poverty of thought. - ANSWER The clinical effects and withdrawal symptoms of amphetamines are similar to those of: Question 38 options: a) Heroine b) Alcohol c) Cocaine

d) Marijuana - ANSWER In which of the following personality disorders would there likely be a lower rate of soft neurological signs? Question 39 options: a) Schizotypal b) Dependent c) Antisocial d) Borderline - ANSWER The neurochemical pathophysiology of Tourette disorder involves: Question 40 options: a) decreased levels of gamma-aminobutyric acid and increased levels of glutamate in the brain. b) deficits in the prefrontal cortex-mediated executive functions of the brain. c) imbalances in dopaminergic, serotonergic, and noradrenergic systems in multiple regions of the brain. d) overstimulation of noradrenergic activity located in the locus coeruleus of the brain. - ANSWER

Before implementing evidence-based practice changes, an adult psychiatric and mental health nurse practitioner's initial action is to: Question 41 options: a) brainstorm with stakeholders and draft a detailed problem list. b) compare data with internal and external benchmarks, and coordinate ongoing education. c) facilitate a collaborative multidisciplinary group to synthesize evidence and compare key themes. d) identify potential barriers and facilitators that reflect patients' values and expectations. - ANSWER Which area of the brain is a very primitive in terms of evolution and is involved in swallowing, arousal, and breathing? Question 42 options: a) Parietal lobe b) Insula c) Cerebellum d) Brainstem - ANSWER For a patient who is overinclusive or rambling, the clinician: Question 43 options: a)

Asks the patient to tell his story b) Uses direction and redirection c) Increases the amount of eye contact d) Interviews the person accompanying the patient - ANSWER Which information concerning the use of e-mail messages is included in the Health Insurance Portability and Accountability Act? Question 44 options: a) E-mail messages are not an acceptable form of communication if they contain any private patient information. b) E-mail messages are suitable only if they contain medical record numbers, instead of patient names. c) E-mail messages are acceptable between health care providers, but not between health care providers and patients. d) E-mail messages containing private patient information are acceptable if the information is encrypted. - ANSWER Which of the following features is associated with positive outcome among patients with schizophrenia? Question 45 options:

a) Younger age of onset b) Male gender c) Living in an industrialized country d) Having positive symptoms - ANSWER Chris, a successful music major, is preparing for his recital next week. He has experienced severe stage fright in the past. Which of the following classes of medication would most likely be recommended? Question 46 options: a) Monoamine oxidase inhibitor b) Tricyclic antidepressant c) Norepinephrine reuptake inhibitor d) Beta blocker - ANSWER The key feature of adjustment disorder is: Question 47 options: a) An anxiety response to a social event such as speaking in public b)

The response to a known stressor that occurs within 3 months of the stressor c) A response to an event that is catastrophic, such as witnessing a murder d) Pervasive anxiety related to a fear of being trapped in an enclosed place - ANSWER Susan, a 35-year-old single female who has a history of panic attacks that interfere with her working, has become afraid to go out alone and prefers to have a family member stay with her at home at all times. The most appropriate diagnosis based on this limited information is: Question 48 options: a) Schizophrenia with delusions b) Panic disorder with agoraphobia c) Avoidant personality disorder d) Social anxiety disorder - ANSWER Which factor is associated with the development of posttraumatic stress disorder? Question 49 options: a) Distorted and negative cognitive functioning b) Excess serotonin and norepinephrine levels c) Severity of the stressor and availability of support systems

d) Unsatisfactory parent-child relationships - ANSWER A psychiatric and mental health nurse evaluates a six-year-old male child, who is timid and clings to his mother. The mother states, "He has been so fearful lately; he will not sleep without the lights on." When the nurse asks whether any event has occurred to cause stress, the mother states, "No, my boyfriend and I argued. He threw some things and yelled, but that was just one time." While the mother is talking, the nurse observes the child cling more closely to his mother. The child's behavior suggests which form of emotional abuse? Question 50 options: a) Corrupting b) Isolating c) Rejecting d) Terrorizing - ANSWER A patient says that she has been becoming increasingly depressed following the birth of her first child 4 months ago. She had an episode of depression in her 20s but recovered. Now, she is becoming more despondent, crying, and sleeping a lot. She fears that she may hurt the baby if she does not get treatment. A possible diagnosis is: Question 51 options: a) Major depressive disorder with melancholic features b) Major depressive disorder with psychotic features c) Dysthymia with superimposed major depression (double depression)

d) Major depressive disorder with postpartum onset Save - ANSWER During the initial assessment of a patient with schizophrenia, in response to the question "What brought you to the clinic today?" a patient's response of "the van" is an example of: Question 52 options: a) Poverty of speech b) Concrete thinking c) Oppositional behavior d) Tangentiality - ANSWER Which nonpharmacologic treatment modality is recommended for depression? Question 53 options: a) Biofeedback b) Dialectical behavioral therapy c) Eye movement desensitization and reprocessing therapy d) Supportive group therapy - ANSWER It can be said that in the fear system, the amygdala:

Question 54 options: a) Serves as a response center for danger and fear b) Imprints the time and place of an event c) Evaluates the event in relation to memories of previous experiences d) Releases hormones that start a cascade of neurohormones and neurotransmitters that prepare the body to respond to a threat - ANSWER The patient says that for the last 5 years, she has begun to feel depressed around the time the golf season ends in November and begins to feel better when she is able to get outdoors to play again in April. When she is depressed, she craves carbohydrates, overeats, and gains weight. She has no energy and wants to sleep all the time and she is irritable and snaps at people. The psychiatric advanced practice nurse considers which of the following diagnoses? Question 55 options: a) Dysthymia b) Major depressive disorder with seasonal pattern c) Adjustment disorder with depressed mood d) Major depressive disorder with atypical features - ANSWER A patient states that she hears voices telling her that she should kill herself. The psychiatric advanced practice nurse states that the patient is:

Question 56 options: a) Experiencing delusions b) Experiencing hallucinations c) Experiencing an aura d) Experiencing a dissociative state - ANSWER Brain imaging techniques have revealed which one of the following anatomic changes in some people with schizophrenia? Question 57 options: a) Increased blood flow in the prefrontal area b) Increased ventricular size c) Increased brain activity in the frontal area d) Enlargement of the thalamus - ANSWER The key feature of acute stress disorder is the presence of: Question 58 options: a) Sleep disturbances b)