NURS 6670 MIDTERM EXAM REVISED 2021
Correct answers marked yellow.
i i i
Question 1 i
Alexa iis ia i27-year-old ifemale iwho ihas icome ito igroup itherapy iwhile ishe iis iin ithe icity ijail. iShe iwas iarrested ifor
ivagrancy ibecause ishe i was isleeping iin iher icar iin ia iparking ilot iat ia ilocal ishopping icenter. iShe icould inot ipost ibail, iso
ishe iis isentenced ito i14 idays iin ijail. iDuring igroup, ishe icontributes ithat inone iof ithis iis iher ifault. iHer imother iis itotally
ievil ibecause ishe i would inot ilet iAlexa istay iin ithe ifamily ihome. iShe ihas isome iother ifamily. ibut ithey iare iall ijerks
because ithey iwon’t ihelp iher. iAlexa’s ifriend iMelanie iis ithe iabsolute ibest iperson iin ithe iworld, ibut ishe ican’t ihelp
ibecause iher iboss ifired iher ifor ino ireason. iAlexa ihas ia ihistory iof iarrests ifor ibuying iillegal idrugs iand iprostitution.
iThe ilast itime ishe i was iin ijail, iher isentence i was iextended ifor i30 idays ibecause ishe igot iinto ia ifight i with ianother
iinmate iand ibeat iher iup iso ibadly ishe ihad ito ibe iadmitted ito ithe ihospital ifor i6 idays. iThe iPMHNP iconsiders i which iof
ithe ifollowing ipersonality idisorders?
Histrionic
Narcissistic
Borderline
Schizoid
Question 2 i
Anne iis ia i32-year-old ifemale iwho ipresented ito icare iafter ia irandom idrug iscreening iat iwork iwas ipositive ifor
icocaine. iShe iwas iinitially iresistant ito itherapy, i maintaining ithat iher iuse iis inot ia iproblem iand ishe icould istop iat iany
itime.
iUpon ifurther idiscussion iin isession, iit iappears ithat ishe iuses icocaine ievery iday iat iwork, isometimes i2–3 itimes, iother
idays i more. iShe ialso iuses iit ioccasionally iat ihome iand imost iweekends. iDuring iher ithird isession, ishe iadmitted ithat iit
iis ia ifinancial iburden, iand ishe ibasically icannot iafford iany iother iform iof irecreation. iShe iunderstands ithat iif ishe iuses
iagain ishe i will ilose iher ijob, iand ishe iadmits ithat ishe iloves iher ijob iand ithat icocaine iis inot iworth ilosing iit. iWhen
icounseling iher iabout icessation istrategies, ithe iPMHNP iadvises iall ithe ifollowing iexcept:
1
, The iphysiologic isymptoms iof iwithdrawal imay irequire ia ishort-term ihospitalization
Unlike iother isubstances iof iabuse, ithere iare ino imedications ito ihelp ireduce ithe iintensity iof iwithdrawal
She iwill ineed ito ibe imonitored ifor idepression
Overcoming ithe iintense icraving ifor icocaine iis ithe ibiggest iissue
• Question i3
Clare’s ihistory iof ipersonal irelationships iis icharacterized iby icomplete iintolerance iof ibeing ialone. iWhether iit iis ian
intimate-partner irelationship ior ia iclose ifriend, iClare iappears ito ialways ineed isomeone iin iher ilife. iShe ihad ia ilive- in
iboyfriend iof i3 iyears, iand iwhile ithey i were itogether, ihe itook icare iof ieverything. iThe iPMHNP iexpects iall iof ithe
ifollowing ito ibe iadditional ifeatures iof iClare’s ihistory iexcept:
Has idisproportionate ianger itoward ian iabusive ispouse
Question 4 i
The iPMHNP iis iconducting ian iinitial iinterview iwith ia ipatient iwhose ihistory iis iconsistent iwith iavoidant ipersonality
idisorder. iThe iPMHNP iunderstands ithat ione iof ithe imost istriking ifeatures iof ithis iinterview iis ilikely ito ibe icentered
iupon ithe ipatient’s:
Clothing
Speech ipattern
Anger
Anxiety
2
,Question 5 i
A iPMHNP istudent iis ireviewing ihis inotes ifrom ihis iclinical iexperience iover ithe ipast iweek ito iprepare ihis ifirst
irequired icase ipresentation ion ia ipatient isuffering ia imajor idepressive iepisode. iWhich iof ithe ifollowing ipatients ibest
irepresents ithe iDSM-5 icriteria ifor imajor idepressive iepisode?
A i27-year-old ifemale iwith ia i1-month ihistory iof isocial iwithdrawal, ianorexia, ihypersomnia, iunprovoked
i outbursts iof ianger, iand ia istrong ifamily ihistory iof iendogenous idepression
A i41-year-old imale iwith ia ihistory iof ichildhood isexual iabuse, iloss iof iinterest iin iboth ihis iprofessional iand
ipersonal ilife, ian iunplanned i10 ilb. iweight iloss iin ithe ilast i3 imonths, iand iperceptual idisturbances
A i65-year-old imale iwhose iwife idied i2 imonths iago iand ihe ireports ia i3-week ihistory iof igenerally idepressed
imood, iguilt iabout ihis i wife’s ideath, iinsomnia, idifficulty ifocusing ion idaily itasks, i with iincreasing ithoughts iof
idying
A i72-year-old ifemale iwho ijust irelocated iacross icountry ito ilive iwith iher iadult ison iand idaughter-in-law iwho iis
despondent iabout ileaving iher ihome iand ireports iforgetfulness, iloss iof iappetite, inew ionset ibowel iproblems, iand
iextreme iloss iof ienergy
Question 6 i
A ivariety iof ipharmacologic iagents ihave idemonstrated ieffectiveness iin ithe itreatment iof ipost-traumatic istress
idisorder. iWhich iof ithe ifollowing idoes inot ihave iany ievidenced-based isupport iin ithe iliterature?
SSRIs
TCAs
Antiadrenergics
Antipsychotics
Question 7 i
The iPMHNP iis ion icall iat ithe ilocal icounty icorrectional ifacility. iHe iis iasked ito ievaluate iM.S., ia i21-year-old imale
i who i was ijust iarrested ifollowing ian ialtercation iat ia ilocal ibar. iM.S. ihas inever ibeen iincarcerated ibefore iand
3
, iapparently ihas ino ipsychiatric ior imedical ihistory iavailable. iHis itoxicology iscreen iwas inegative ifor ialcohol ior iany
idrugs iof iabuse.
His imother isays ithat ihe ihas iin ithe ipast ihad isome ioccasions iwhen ihe igot ikind iof iagitated, ibut ithis iis ithe ifirst itime iit’s
ibeen ia iproblem. iReportedly isome ipeople ifrom ihis ioffice i were iat ithe ibar icelebrating ia ibirthday, iand ibefore ianyone
iknew i what ihappened ian iargument iescalated iinto iM.S. igetting ivery iloud, iyelling, iand iacting i―crazy‖ ibefore ihe
ipunched ia icoworker iand istarted ibreaking ibottles. iWhen iconsidering ia imanic ior ihypomanic iepisode, ithe iPMHNP
Stuttered
Increased
Childlike
Confused
Question 8 i
Fletcher iis ia i29-year-old imale ireferred ifor icourt-ordered icounseling. iHe ihas ia ilong ihistory iof irepeated ioffenses
iincluding iDUI, idomestic iviolence, ibattery, iand iother iviolent iacts ithat ifortunately ihave inot iyet icaused iany iserious
iinjury ior ideath ito ithe irecipients. iAn iinterview i with ihis i wife ireveals ithat ihe ihas ilied iabout ialmost ieverything ifor ithe
last ifew iyears; ihe iis iable ito iget ihired ifor ijobs ibecause ihe iis ivery iengaging iand ilikeable, iand ithen iinvariably ihe igets
ifired ibecause ihe imisses i work iand idoesn’t ido ihis ijob iproperly i when ihe iis ithere. iAccording ito ithe iwife, ithey ihave
iknown ieach iother isince ihigh ischool, i where iFletcher i was ivery ihappy iand i well-adjusted. iHe iwas ion ithe isoccer
iteam, iliked iby iteachers, iand inever idemonstrated ithe itendencies ihe idoes inow. iApparently iin icollege ihe igot
iinvolved iwith ia ifraternity ithat i was inotorious ifor ialcohol iand idrug iabuse, iand ihe istarted idrinking iheavily; iit i was
i―all idownhill ifrom there.‖ iThe iPMHNP iconsiders ithat:
History iand isymptoms iare imost iconsistent iwith iantisocial ipersonality idisorder
Fletcher ineeds ia ineurological iworkup ito iinclude ian iEEG iand iassessment ifor ineurological isoft isigns
Consistent iwith ihis isymptoms, iFletcher iwill ilikely irespond iwell ito ia istress iinterview
It iis ilikely ithat isubstance iabuse iis ithe iunderlying icause iof isymptoms iand ishould ibe iexplored ifurther
4
Correct answers marked yellow.
i i i
Question 1 i
Alexa iis ia i27-year-old ifemale iwho ihas icome ito igroup itherapy iwhile ishe iis iin ithe icity ijail. iShe iwas iarrested ifor
ivagrancy ibecause ishe i was isleeping iin iher icar iin ia iparking ilot iat ia ilocal ishopping icenter. iShe icould inot ipost ibail, iso
ishe iis isentenced ito i14 idays iin ijail. iDuring igroup, ishe icontributes ithat inone iof ithis iis iher ifault. iHer imother iis itotally
ievil ibecause ishe i would inot ilet iAlexa istay iin ithe ifamily ihome. iShe ihas isome iother ifamily. ibut ithey iare iall ijerks
because ithey iwon’t ihelp iher. iAlexa’s ifriend iMelanie iis ithe iabsolute ibest iperson iin ithe iworld, ibut ishe ican’t ihelp
ibecause iher iboss ifired iher ifor ino ireason. iAlexa ihas ia ihistory iof iarrests ifor ibuying iillegal idrugs iand iprostitution.
iThe ilast itime ishe i was iin ijail, iher isentence i was iextended ifor i30 idays ibecause ishe igot iinto ia ifight i with ianother
iinmate iand ibeat iher iup iso ibadly ishe ihad ito ibe iadmitted ito ithe ihospital ifor i6 idays. iThe iPMHNP iconsiders i which iof
ithe ifollowing ipersonality idisorders?
Histrionic
Narcissistic
Borderline
Schizoid
Question 2 i
Anne iis ia i32-year-old ifemale iwho ipresented ito icare iafter ia irandom idrug iscreening iat iwork iwas ipositive ifor
icocaine. iShe iwas iinitially iresistant ito itherapy, i maintaining ithat iher iuse iis inot ia iproblem iand ishe icould istop iat iany
itime.
iUpon ifurther idiscussion iin isession, iit iappears ithat ishe iuses icocaine ievery iday iat iwork, isometimes i2–3 itimes, iother
idays i more. iShe ialso iuses iit ioccasionally iat ihome iand imost iweekends. iDuring iher ithird isession, ishe iadmitted ithat iit
iis ia ifinancial iburden, iand ishe ibasically icannot iafford iany iother iform iof irecreation. iShe iunderstands ithat iif ishe iuses
iagain ishe i will ilose iher ijob, iand ishe iadmits ithat ishe iloves iher ijob iand ithat icocaine iis inot iworth ilosing iit. iWhen
icounseling iher iabout icessation istrategies, ithe iPMHNP iadvises iall ithe ifollowing iexcept:
1
, The iphysiologic isymptoms iof iwithdrawal imay irequire ia ishort-term ihospitalization
Unlike iother isubstances iof iabuse, ithere iare ino imedications ito ihelp ireduce ithe iintensity iof iwithdrawal
She iwill ineed ito ibe imonitored ifor idepression
Overcoming ithe iintense icraving ifor icocaine iis ithe ibiggest iissue
• Question i3
Clare’s ihistory iof ipersonal irelationships iis icharacterized iby icomplete iintolerance iof ibeing ialone. iWhether iit iis ian
intimate-partner irelationship ior ia iclose ifriend, iClare iappears ito ialways ineed isomeone iin iher ilife. iShe ihad ia ilive- in
iboyfriend iof i3 iyears, iand iwhile ithey i were itogether, ihe itook icare iof ieverything. iThe iPMHNP iexpects iall iof ithe
ifollowing ito ibe iadditional ifeatures iof iClare’s ihistory iexcept:
Has idisproportionate ianger itoward ian iabusive ispouse
Question 4 i
The iPMHNP iis iconducting ian iinitial iinterview iwith ia ipatient iwhose ihistory iis iconsistent iwith iavoidant ipersonality
idisorder. iThe iPMHNP iunderstands ithat ione iof ithe imost istriking ifeatures iof ithis iinterview iis ilikely ito ibe icentered
iupon ithe ipatient’s:
Clothing
Speech ipattern
Anger
Anxiety
2
,Question 5 i
A iPMHNP istudent iis ireviewing ihis inotes ifrom ihis iclinical iexperience iover ithe ipast iweek ito iprepare ihis ifirst
irequired icase ipresentation ion ia ipatient isuffering ia imajor idepressive iepisode. iWhich iof ithe ifollowing ipatients ibest
irepresents ithe iDSM-5 icriteria ifor imajor idepressive iepisode?
A i27-year-old ifemale iwith ia i1-month ihistory iof isocial iwithdrawal, ianorexia, ihypersomnia, iunprovoked
i outbursts iof ianger, iand ia istrong ifamily ihistory iof iendogenous idepression
A i41-year-old imale iwith ia ihistory iof ichildhood isexual iabuse, iloss iof iinterest iin iboth ihis iprofessional iand
ipersonal ilife, ian iunplanned i10 ilb. iweight iloss iin ithe ilast i3 imonths, iand iperceptual idisturbances
A i65-year-old imale iwhose iwife idied i2 imonths iago iand ihe ireports ia i3-week ihistory iof igenerally idepressed
imood, iguilt iabout ihis i wife’s ideath, iinsomnia, idifficulty ifocusing ion idaily itasks, i with iincreasing ithoughts iof
idying
A i72-year-old ifemale iwho ijust irelocated iacross icountry ito ilive iwith iher iadult ison iand idaughter-in-law iwho iis
despondent iabout ileaving iher ihome iand ireports iforgetfulness, iloss iof iappetite, inew ionset ibowel iproblems, iand
iextreme iloss iof ienergy
Question 6 i
A ivariety iof ipharmacologic iagents ihave idemonstrated ieffectiveness iin ithe itreatment iof ipost-traumatic istress
idisorder. iWhich iof ithe ifollowing idoes inot ihave iany ievidenced-based isupport iin ithe iliterature?
SSRIs
TCAs
Antiadrenergics
Antipsychotics
Question 7 i
The iPMHNP iis ion icall iat ithe ilocal icounty icorrectional ifacility. iHe iis iasked ito ievaluate iM.S., ia i21-year-old imale
i who i was ijust iarrested ifollowing ian ialtercation iat ia ilocal ibar. iM.S. ihas inever ibeen iincarcerated ibefore iand
3
, iapparently ihas ino ipsychiatric ior imedical ihistory iavailable. iHis itoxicology iscreen iwas inegative ifor ialcohol ior iany
idrugs iof iabuse.
His imother isays ithat ihe ihas iin ithe ipast ihad isome ioccasions iwhen ihe igot ikind iof iagitated, ibut ithis iis ithe ifirst itime iit’s
ibeen ia iproblem. iReportedly isome ipeople ifrom ihis ioffice i were iat ithe ibar icelebrating ia ibirthday, iand ibefore ianyone
iknew i what ihappened ian iargument iescalated iinto iM.S. igetting ivery iloud, iyelling, iand iacting i―crazy‖ ibefore ihe
ipunched ia icoworker iand istarted ibreaking ibottles. iWhen iconsidering ia imanic ior ihypomanic iepisode, ithe iPMHNP
Stuttered
Increased
Childlike
Confused
Question 8 i
Fletcher iis ia i29-year-old imale ireferred ifor icourt-ordered icounseling. iHe ihas ia ilong ihistory iof irepeated ioffenses
iincluding iDUI, idomestic iviolence, ibattery, iand iother iviolent iacts ithat ifortunately ihave inot iyet icaused iany iserious
iinjury ior ideath ito ithe irecipients. iAn iinterview i with ihis i wife ireveals ithat ihe ihas ilied iabout ialmost ieverything ifor ithe
last ifew iyears; ihe iis iable ito iget ihired ifor ijobs ibecause ihe iis ivery iengaging iand ilikeable, iand ithen iinvariably ihe igets
ifired ibecause ihe imisses i work iand idoesn’t ido ihis ijob iproperly i when ihe iis ithere. iAccording ito ithe iwife, ithey ihave
iknown ieach iother isince ihigh ischool, i where iFletcher i was ivery ihappy iand i well-adjusted. iHe iwas ion ithe isoccer
iteam, iliked iby iteachers, iand inever idemonstrated ithe itendencies ihe idoes inow. iApparently iin icollege ihe igot
iinvolved iwith ia ifraternity ithat i was inotorious ifor ialcohol iand idrug iabuse, iand ihe istarted idrinking iheavily; iit i was
i―all idownhill ifrom there.‖ iThe iPMHNP iconsiders ithat:
History iand isymptoms iare imost iconsistent iwith iantisocial ipersonality idisorder
Fletcher ineeds ia ineurological iworkup ito iinclude ian iEEG iand iassessment ifor ineurological isoft isigns
Consistent iwith ihis isymptoms, iFletcher iwill ilikely irespond iwell ito ia istress iinterview
It iis ilikely ithat isubstance iabuse iis ithe iunderlying icause iof isymptoms iand ishould ibe iexplored ifurther
4
