NUR 668 QUESTIONS AND ANSWERS
Jane is a 27 year old female with no previous psychiatric hx. She was employed at a
large company within the outside sales division. The company recently downsized and
eliminated 50% of its workforce. Jane was let go 1 month ago. She had recently
purchased a condominium near her former employer and expressed worry about the
mortgage payment. She stopped attending her weekly outings with her friends from
college and no longer attends yoga. She is often tearful and notes that 1-2x a week, she
will feel overwhelmed with hopelessness. She denies SI. She denies changes in
appetite, weight, sleep or energy level. She has been able to update her resume and
denies trouble concentrating. She finds pleasure walking her dog, but is seeking help
with her "crying".
Given the current info above, what disorder best describes Jane's symptoms? -
Answers -adjustment disorder with depressed mood
*key is that it is not chronic
Susan is a 22 year old female who has a marked fear of elevators, Uber rides and
public transportation. She never shops or travels alone. She is now experiencing
"nervousness" when she waits in line at the grocery store. Her husband suggested that
she receive counseling after she recently refused to go into Walmart alone.
1. What disorder best describes Susan's behavior?
2. What 1st line pharmacological tx would reduce relapse? - Answers -1. Agoraphobia
2. SSRI's
*note: one can be diagnosed with agoraphobia and not necessarily panic disorder
Michelle, a 28 year old female began having recurring thoughts about people dying
somewhere in the USA. One month later, she learns on social media that an act of
terrorism occurred on the opposite coast. She felt strongly that she played a role in the
act by merely thinking of the act. She complains that the more she tries to not think
about the thought, the more often she has the unwanted thought.
1. Michelle linking of the terrorist act to her previous unwanted thought is an example of
what?
2. What common disorder is this associated with?
3. When treating this disorder with pharmacotherapy, would the PMHNP expect to
prescribe lower or higher dosing of medication compared to the pharmacotherapy of
depression? - Answers -1. Magical thinking
2. OCD
3. Higher
Jim is an 73 year old male with a dx of Major Neurocognitive Disorder. Jim developed
parkinsonism around the same time his cognitive impairment became more
pronounced. Jim was admitted to a nursing home after his wife could no longer care for
him at home at night. Some nights he would hallucinate and some nights he would fall
, out of bed or act out his dreams. Jim was recently prescribed Haloperidol after believing
the FBI was listening to him in the ceiling tiles. He started to tear down the ceiling at his
long term care facility. Jim became rigid after receiving his second dose of Haloperidol.
Which Major Neurocognitive disorder does Jim likely have? - Answers -Dementia with
Lewy Bodies (DLB)
*key information: major neurocognitive disorder with delusions, rigidity/sensitivity to
antipsychotic meds, timing and parkinsonism (PDD, parkinsonism symptoms then
cognitive impairment)
April is a 29 year old female who presents to your office for the first time. She is on
Zyprexa 10mg PO qHS. April never had delusions or hallucinations.
Can one have a diagnosis of schizophrenia without having prior delusions or
hallucinations? - Answers -Yes
*at least one of 3: delusions, hallucinations, disorganized speech
Which of the following statements are true regarding the literature and suicide?
1. asking a patient about suicide may increase the risk of suicide attempt.
2. women attempt more often.
3. Men attempt more often.
4. making a will and a lack of future plans imply an increased risk of suicide.
5. persons of the Muslim faith have higher rates of suicide. - Answers -All even #'s are
true:
2. women attempt more often.
4. making a will and a lack of future plans imply an increased risk of suicide.
Jack is a 19 year old male who survived a motor vehicle accident with minor injuries.
His best friend and passenger did not survive the crash. Approximately 2 days after the
accident, Jack began having recurrent distressing dreams and flashbacks of the
accident. Jack has been avoiding driving for 10 days now. In addition to negative mood,
Jack has been hypervigilant, complained of poor sleep, struggling at work, very easy to
startle and refusing to talk about the accident in social situations.
1. Identify the 2 most likely diagnosis.
2. One key factor which would distinguish between the two? - Answers -1. Acute Stress
Disorder (ASD) or PTSD
2. Duration of symptoms
*PTSD symptoms > 1 month
Lance is very serious and is described as "uptight" by his coworkers. Lance often reads
hidden meanings into benign jokes at work. Lance's friend got a promotion at work this
year and Lance feels betrayed by both his friend and his boss. Lance has accused his
Jane is a 27 year old female with no previous psychiatric hx. She was employed at a
large company within the outside sales division. The company recently downsized and
eliminated 50% of its workforce. Jane was let go 1 month ago. She had recently
purchased a condominium near her former employer and expressed worry about the
mortgage payment. She stopped attending her weekly outings with her friends from
college and no longer attends yoga. She is often tearful and notes that 1-2x a week, she
will feel overwhelmed with hopelessness. She denies SI. She denies changes in
appetite, weight, sleep or energy level. She has been able to update her resume and
denies trouble concentrating. She finds pleasure walking her dog, but is seeking help
with her "crying".
Given the current info above, what disorder best describes Jane's symptoms? -
Answers -adjustment disorder with depressed mood
*key is that it is not chronic
Susan is a 22 year old female who has a marked fear of elevators, Uber rides and
public transportation. She never shops or travels alone. She is now experiencing
"nervousness" when she waits in line at the grocery store. Her husband suggested that
she receive counseling after she recently refused to go into Walmart alone.
1. What disorder best describes Susan's behavior?
2. What 1st line pharmacological tx would reduce relapse? - Answers -1. Agoraphobia
2. SSRI's
*note: one can be diagnosed with agoraphobia and not necessarily panic disorder
Michelle, a 28 year old female began having recurring thoughts about people dying
somewhere in the USA. One month later, she learns on social media that an act of
terrorism occurred on the opposite coast. She felt strongly that she played a role in the
act by merely thinking of the act. She complains that the more she tries to not think
about the thought, the more often she has the unwanted thought.
1. Michelle linking of the terrorist act to her previous unwanted thought is an example of
what?
2. What common disorder is this associated with?
3. When treating this disorder with pharmacotherapy, would the PMHNP expect to
prescribe lower or higher dosing of medication compared to the pharmacotherapy of
depression? - Answers -1. Magical thinking
2. OCD
3. Higher
Jim is an 73 year old male with a dx of Major Neurocognitive Disorder. Jim developed
parkinsonism around the same time his cognitive impairment became more
pronounced. Jim was admitted to a nursing home after his wife could no longer care for
him at home at night. Some nights he would hallucinate and some nights he would fall
, out of bed or act out his dreams. Jim was recently prescribed Haloperidol after believing
the FBI was listening to him in the ceiling tiles. He started to tear down the ceiling at his
long term care facility. Jim became rigid after receiving his second dose of Haloperidol.
Which Major Neurocognitive disorder does Jim likely have? - Answers -Dementia with
Lewy Bodies (DLB)
*key information: major neurocognitive disorder with delusions, rigidity/sensitivity to
antipsychotic meds, timing and parkinsonism (PDD, parkinsonism symptoms then
cognitive impairment)
April is a 29 year old female who presents to your office for the first time. She is on
Zyprexa 10mg PO qHS. April never had delusions or hallucinations.
Can one have a diagnosis of schizophrenia without having prior delusions or
hallucinations? - Answers -Yes
*at least one of 3: delusions, hallucinations, disorganized speech
Which of the following statements are true regarding the literature and suicide?
1. asking a patient about suicide may increase the risk of suicide attempt.
2. women attempt more often.
3. Men attempt more often.
4. making a will and a lack of future plans imply an increased risk of suicide.
5. persons of the Muslim faith have higher rates of suicide. - Answers -All even #'s are
true:
2. women attempt more often.
4. making a will and a lack of future plans imply an increased risk of suicide.
Jack is a 19 year old male who survived a motor vehicle accident with minor injuries.
His best friend and passenger did not survive the crash. Approximately 2 days after the
accident, Jack began having recurrent distressing dreams and flashbacks of the
accident. Jack has been avoiding driving for 10 days now. In addition to negative mood,
Jack has been hypervigilant, complained of poor sleep, struggling at work, very easy to
startle and refusing to talk about the accident in social situations.
1. Identify the 2 most likely diagnosis.
2. One key factor which would distinguish between the two? - Answers -1. Acute Stress
Disorder (ASD) or PTSD
2. Duration of symptoms
*PTSD symptoms > 1 month
Lance is very serious and is described as "uptight" by his coworkers. Lance often reads
hidden meanings into benign jokes at work. Lance's friend got a promotion at work this
year and Lance feels betrayed by both his friend and his boss. Lance has accused his
