Exam (elaborations) NUR 6640 midterm

Exam (elaborations) NUR 6640 midterm Week 6 Midterm Exam Started 7/8/20 5:19 PM Submitted 7/8/20 6:29 PM Due Date 7/13/20 1:59 AM Status Completed Attempt Score 73 out of 75 points Time Elapsed 1 hour, 10 minutes out of 2 hours Results Displayed Submitted Answers Question 1 1 out of 1 points During cognitive behavioral therapy (CBT), a 64-year-old male patient states, “I get so frustrated sometimes and I just blow up at everybody!” Which response by the PMHNP demonstrates translation of Socratic dialogue (SD)? Selected Answer: B. “When you say blow up, what exactly does blow up mean and how does it feel to you?” Question 2 1 out of 1 points A 62-year-old patient has been diagnosed with borderline personality disorder. Upon assessment, the PMHNP learns that he participates in spending sprees and occasional binge eating, accompanied by rapid changes in self-image. Which evidence-based psychotherapeutic model does the PMHNP identify as effective and beneficial? Selected Answer: C. Dialectical behavior therapy Question 3 1 out of 1 points false NUR 6640 Midterm A 35-year-old patient has been seeking treatment for depression for several months. The PMHNP does an assessment to see if processing has led to adaptive change. The patient’s selfreferences are positive in relation to past events, work is productive, relationships are adaptive, and there is congruence between behavior, thoughts, and affect. Based on this information, the PMHNP decides the patient ____________. Selected Answer: C. is ready to move to Stage III, future visioning Question 4 1 out of 1 points During a session, the PMHNP asks a patient with a history of sexual abuse to recall the relationship she had as a child with her parents. The patient responds by saying she has a headache and her stomach hurts, and starts talking about her physical ailments. What is the appropriate response by the PMHNP? Selected Answer: A. Assure the patient that she does not have to discuss these memories Question 5 1 out of 1 points A 24-year-old female patient presents for her initial appointment with the PMHNP. Which action will the PMHNP take to establish therapeutic alliance? Selected Answer: D. All of the above Question 6 1 out of 1 points The PMHNP is working with a school-aged child who has been diagnosed with depression. The child has attended several sessions with the PMNHP, but recently presents with avoidant behavior by showing increased distress and being late to sessions. What approach does the PMHNP need to employ with the child to continue making therapeutic progress? Selected Answer: B. Using communication techniques that are expressive Question 7 1 out of 1 points The PMHNP has been assisting a shy and timid 23-year-old male patient struggling with esteem and self-concept issues. Over the weekend, this patient was given the task of completing an exercise that would usually cause him distress and shame, also called a shameattacking exercise. The PMHNP determines that this task has successfully been achieved when the patient states: Selected Answer: A. “I was able to eat in public yesterday despite how loudly I chew.” Question 8 1 out of 1 points The PMHNP is meeting with a new patient who is a young veteran back from serving two tours overseas. When reviewing the patient’s health history file that was sent from the VA, the PMHNP learns that several months ago, the patient was diagnosed with PTSD, but never followed up with treatment for it. After a comprehensive mental health assessment, the PMHNP confirms the PTSD diagnosis and understands that which therapeutic approach will be the most effective as a first-line treatment modality? Selected Answer: B. Employing cognitive behavioral therapy with the patient Question 9 1 out of 1 points An initial evaluation reveals that an 11-year-old patient has moved to a new school after her parents’ recent divorce, and is having trouble making friends. The patient has normal mental status and exhibits appropriate behavior. What is the most appropriate scale for the PMHNP to use to get more information? Selected Answer: D. Impact of Event Scale Question 10 1 out of 1 points A patient who has borderline personality disorder is meeting with the PMHNP. When asked about future goals, the patient responds, “I’d like to go back to school to do what you do. You know, talk to people all day about their problems. It seems pretty easy.” How does the PHMNP respond to the client in a way that is free from any stigmatizing beliefs or judgments? Selected Answer: C. “You may want to explore the requirements for becoming a PMNHP.” Question 11 1 out of 1 points After informing a prospective patient about limits of confidentiality, the patient consents to the “conditions” of confidentiality and signs an informed consent form. Several weeks later, a lawyer representing the patient’s spouse for a court case, asks the PMHNP for the disclosure of information about the patient. The PMHNP should: Selected Answer: C. Limit disclosure to the extent legally possible Question 12 1 out of 1 points The PMHNP is working with a patient who has insomnia and battles going to sleep. The patient reports consistent self-defeating behaviors, and hates trying to go to sleep. Which action made by the PMHNP demonstrates the use of a paradoxical intervention? Selected Answer: B. Telling the patient to resist sleep and stay awake Question 13 1 out of 1 points The PMHNP is working with a patient who seems dissatisfied with the therapeutic relationship. The PMHNP invites the patient to discuss her feelings regarding the PMHNP openly and honestly. It becomes clear to the PMHNP that they are experiencing an alliance rupture. How does the PMHNP repair the therapeutic alliance? Selected Answer: D. All of the above Question 14 1 out of 1 points One of the strategies the PMHNP wants to try includes sleep restriction. What will the PMHNP suggest to follow sleep restriction therapy? Selected Answer: B. “Restrict the amount of time you spend in bed.” Question 15 1 out of 1 points The PMHNP is caring for a patient who has acute stress disorder after experiencing a traumatic event 1 week prior. The PMHNP wants to begin with a therapeutic framework that follows the adaptive information processing (AIP) model. What is the priority action for the PMHNP to take? Selected Answer: A. Focus on the patient’s safety and stabilization Question 16 1 out of 1 points A middle-aged man who works over 50 hours a week is being seen for depression and anger management. He states, “I am even more frustrated when I come home and my wife wants to argue about stupid stuff. All I want to do is come home, take a shower, and eat. Is that too much to ask?” The PMHNP explains that people can be assertive, aggressive, and passive. She encourages the patient to be more assertive and begins role-play with assertive training. The PMHNP determines that the patient is beginning to understand when he states: Selected Answer: D. “I feel frustrated when I come home and we argue.” Question 17 1 out of 1 points The PMHNP is conducting a peer review of another PMHNP’s medical charts. Upon review, the PMHNP notes that the peer often begins patient sessions late, as well as ends them later than scheduled. The PMHNP also found a comment in the chart regarding the patient sending text messages while in the middle of the session. Based on these findings, the feedback that the PMHNP will provide to the peer involves which therapeutic principle? Selected Answer: D. Maintaining the frame 32.The PMHNP is mentoring a student. After working with a patient during a session, the student laments about all the things she should have, or could have, said to the patient. “I feel guilty that I didn’t speak up more about the patient’s concern toward her son,” says the student. The PMHNP understands that the student is exhibiting signs of which therapeutic concept? Question 18 1 out of 1 points The PMHNP employs psychodynamic psychotherapy with a patient who experiences anxiety and depression. As the process enters the psychoanalytic end of the psychodynamic continuum, the PMNHP will focus on: Selected Answer: A. Interpreting unconscious conflict in the patient Question 19 1 out of 1 points The PMHNP is working with an adult patient who has somatic complaints caused by a history of childhood abuse. As part of the therapeutic process, what does the PMHNP do to assess and organize a trauma history? Selected Answer: B. Construct a timeline of the patient’s life Question 20 1 out of 1 points The PMHNP is treating a patient with a substantial fear of feeling closed in (claustrophobia). Thus, the patient will not get into an elevator. The office where he works is on the 10th floor and this requires that he walk up and down the stairs in the morning and evening to get to his office. With permission from the patient, the PMHNP is beginning systematic desensitization to address the patient’s need to use the elevator. What is the PMHNP’s best plan of action? Selected Answer: A. Begin by having the patient stand in front of the elevator and write down his feelings Question 21 1 out of 1 points True or false: If after a third round of processing followed by stabilization, a patient has increased anxiety that requires further interventions aimed at stabilization, the therapeutic relationship can no longer successfully provide therapeutic change. Selected Answer: False Question 22 1 out of 1 points When a PMHNP is seeing a patient for the first time, what is an important step to assure that the patient and provider understand the limits of their discussion? Selected Answer: C. Have a discussion about the confidentiality and its limits Question 23 1 out of 1 points The PMHNP is mentoring a student. After working with a patient during a session, the student laments about all the things she should have, or could have, said to the patient. “I feel guilty that I didn’t speak up more about the patient’s concern toward her son,” says the student. The PMHNP understands that the student is exhibiting signs of which therapeutic concept? Selected Answer: A. Countertransference Question 24 1 out of 1 points True or false: A PMHNP may ask his patient to describe her relationship with her father, both as a child and now, in order to assess interpersonal style. Selected Answer: False Question 25 1 out of 1 points The PMHNP is working with a patient who experiences anxiety around her parents that later leads to poor impulse control. What will the PMHNP do to employ psychodynamic psychotherapy properly for this patient? Selected Answer: D. All of the above Question 26 1 out of 1 points In your office, you see a 58-year-old patient with PTSD who reports having nightmares, making it impossible for her to sleep. What recommendations based on principles of sleep hygiene will the PMHNP make? Selected Answer: C. Avoid watching television or reading in bed Question 27 1 out of 1 points A PMHNP has been working with a young female patient who suffers from depression to change self-defeating behaviors. By creating a presence of acceptance and using good listening skills, the PMHNP’s overall goal is to __________. Selected Answer: A. deepen the patient’s understanding of herself in order to cultivate empowerment Question 28 1 out of 1 points The PMHNP is assessing a patient who grew up in a foster home because she was neglected and abused by her birth parents at a young age. The patient admits to having difficulty forming and maintaining relationships throughout her life. Understanding maladaptive schemas, which statement does the PMHNP predict that the patient is likely to make? Selected Answer: C. “It takes me a while to warm up to people; people often wear masks.” Question 29 1 out of 1 points The PMHNP understands that anxiety and depression are two disorders in which their symptoms may overlap. When discussing this, you explain that the autonomic nervous system is activated and further helps distinguish anxiety symptoms by making the following points: Selected Answer: B. “You may experience fear, sweating, and muscle tension.” Question 30 1 out of 1 points At the initial interview with a patient, the PMHNP reviews the condition of receiving services, including limits that will be imposed on confidentiality. During the discussion, the patient shares information that the PMHNP is legally required to report. True or false: If the PMHNP does not report information that s/he is legally required to report, state laws govern the consequences which include penalties for not reporting, especially child and elder abuse. Selected Answer: True Question 31 1 out of 1 points The PMHNP has a session with a patient who was injured and traumatized from an explosion at the industrial plant where he used to work. During the session, an outside noise startles the patient and he experiences a flashback of the loud boom from the explosion. The PMHNP witnesses the patient present with anxiety and belabored breathing. What is the appropriate action of the PMHNP? Selected Answer: D. Have the patient use the relaxation response (take a deep breath, exhale long, and slow down) Question 32 1 out of 1 points An elderly patient in a nursing home has been losing interest in activities and now refuses to leave his room. After a physical exam, he is referred to a PMHNP for an initial assessment. True or false: After speaking with the patient, an appropriate screening tool for the PMHNP to use would be the Geriatric Depression Scale. Selected Answer: True Question 33 1 out of 1 points During a therapy session the patient is asked how she currently deals with stress, and she says, “Well, I don’t. I just let it build and build.” The PMHNP responds by asking how well this has been working out for her. The patient states, “Well, to be honest, it just feels like I’m drowning, you know what I mean.” Illustrating idiosyncratic meaning, the PMHNP responds with: Selected Answer: B. “No, I am not sure what you are saying. Can you please explain?” Question 34 1 out of 1 points The PMHNP is working with a patient who is living in poverty and abusing substances. According to the treatment hierarchy framework, what needs does the PMHNP need to attend to first? Selected Answer: A. Provide safety through case management strategies Question 35 1 out of 1 points The PMHNP is having a therapy session with Charlotte, a 20-year-old victim of date rape. The patient states, “I shouldn’t have been there; I should have just gone home. This was all my fault; how could I have been so stupid?” Using the Socratic method, what is the PMHNP’s best response? Selected Answer: A. “If this had happened to someone else with the exact same circumstances, would you say this was her fault?” Question 36 1 out of 1 points An 11-year-old patient has been exhibiting low self-esteem at school and acting out. According to Maslow’s hierarchy of needs, which of the following questions would best be addressed first by the PMHNP? Selected Answer: C. “Is Joel getting enough sleep at home?” Question 37 1 out of 1 points The PMHNP is treating a 35-year-old male officer in the military. He discloses that both of his parents are deceased and that he loved them. However, he says that he had feelings of inadequacy because his parents held him to a standard that he could never achieve. He went on to say that nothing he did ever felt good enough. The PMHNP assesses that this patient has perfect creases in his uniform with no strings or tags out of place; she also notices that he has perfect posture and questions him about ritualistic behaviors. She suspects that this patient has maladaptive responses to the expectations placed on him as a teenager and young adult. Which statements made by the patient would verify the PMHNP’s suspicion? Selected Answer: D. “I believe in systems; I have to have order and rules in my everyday life. If a task must be completed, I will often complete it myself versus depending on someone else.” Question 38 1 out of 1 points A PMHNP’s patients have already signed confidentiality agreements, including limits that will be imposed on confidentiality. Months later, the state’s laws have changed that affect confidentiality promises the PMHNP has already made. What is an appropriate step for the PMHNP to take after finding out this information? Selected Answer: D. All of the above Question 39 1 out of 1 points The PMHNP has been treating a 15-year-old patient with a history of abuse and neglect. Thirty minutes into their therapy session the patient jumps up and begins to pace around the room. Utilizing Socratic dialogue (SD) the PMHNP’s best action would be to: Selected Answer: C. Say, “I noticed a change. Can you tell me what happened?” Question 40 1 out of 1 points A 28-year-old male patient is experiencing distress related to the workplace. What might the PMHNP ask to assess affective development? Selected Answer: D. All of the above. Question 41 1 out of 1 points The PMHNP meets with an adolescent patient who has depression and often presents with resistance when discussing his parent’s divorce. For the past couple of sessions, the patient has been quiet, sometimes refusing to speak. To further support the therapeutic relationship, the PMNHP: Selected Answer: A. Observes and points out the behavior Question 42 1 out of 1 points A PMHNP is preparing confidentiality forms for his patients. What is the most appropriate first step he should take? Selected Answer: B. Research his profession’s ethics code and state/federal laws Question 43 1 out of 1 points The PMHNP is caring for a patient who the PMHNP believes