NURS 6670 Final Exam - With ANSWER ELABORATIONS [LATEST 75 Out of 75]

NURS 6670 Final Exam Review - LATEST With Feedback Elaborations QUESTION 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. Head imaging, screening lab, and a toxicology screen are negative. A leading differential for Collette is: Bipolar disorder Acute psychotic episode Schizophreniform disorder Post-traumatic stress disorder Feedback: 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 Represent a disorder of REM sleep May be a symptom of temporal lobe epilepsy Is treated with a cycle of sleep deprivation Feedback: As observed of the presented situation above, one may conclude that night terrors are often associated with trauma or psychiatric problems. This parasomnia is often exacerbated by excess stress caused by sleep deprivation, uncompleted tasks done during the morning, or related to frontal lobe epileptic cases. Night terrors, also referred to as sleep terrors, are a type of parasomnia, classified as an arousal disorder, that occurs during non-REM (NREM) sleep. This parasomnia occurs during the first 3 to 4 hours of the night. An individual that is experiencing a night terror will suddenly begin to exhibit signs of panic and terror while sleeping such as screaming or kicking. This phenomena is accompanied by other symptoms like rapid heart rate and breathing, flushing of the skin, sweating, and musculature tensing. 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 Increased dopamine activity in the mesocortical pathway Increased glutamate in the prefrontal cortex Increased glutamate in the hippocampus Feedback: Neurophysiologic theory of Schizophrenia suggests that Jack's symptoms were a result of over activity in the mesolimbic dopamine pathway Neurophysiologic theory of Schizophrenia suggests that Jack's symptoms were a result of over activity in the mesolimbic dopamine pathway causing delusion hallucinations . Thus when a typical First generation antipsychotic like Haloperidol (which is antagonist of dopamine D2 and D3 receptor) given ,it worked well and symptoms subsided . Thus it proves that jack symptoms where due to dopamine pathway over activity.