NRNP 6640 MIDTERM EXAM 2023/2024 Questions and Answers

QUESTION 1 1. 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: 2. A “You may experience an elevated heart rate, constant worrying, . and diarrhea.” B “You may experience fear, sweating, and muscle tension.” . C “You may experience an elevated heart rate, the need to urinate, . and fear.” D “You may experience sleepiness, decreased blood pressure, and . fear.” QUESTION 2 1. 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? D All of the . above QUESTION 3 1. 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: 2. C Limit disclosure to the extent legally . possible QUESTION 4 1. 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? C Avoid watching television or reading . in bed QUESTION 5 1. 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? 2. C “Is Joel getting enough sleep at . home?” QUESTION 6 1. A patient named Steve is seeking therapy to get help with his home situation, stating that he has been stressed since his mother-in-law moved into the house. What can the PMHNP do to assist the patient in constructing a narrative? 2. B Elicit details so Steve becomes more self-disclosing and . self-examining QUESTION 7 1. A new patient has been informed of the limits of confidentiality, and has signed informed consent forms. No consent, however, has been obtained for voluntary “Release of Information.” The patient is 20 years old and still lives at home with his parents. He is being treated for depression, which he attributes to the trouble he’s had finding employment. True or false: If the patient’s mother calls the PMHNP to check up on her son to see how he is doing, the therapist is required to protect patient confidentiality and not disclose information. True QUESTION 8 1. The PMHNP is caring for a patient with borderline personality disorder. Using a psychoanalytic psychotherapy approach, the PMHNP attempts to intensify the patient’s transference to enhance emotional processing by: 2. A Developing increased boundaries . B Decreasing supportive . psychotherapy C Scaling back contact with the patient . D Increasing the number of sessions . per week QUESTION 9 1. 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. True False QUESTION 10 1. 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? 2. A Telling the patient there is no reason to be startled . B Avoiding interrupting the flashback as it occurs . C Asking the patient to describe the flashbacks . D Have the patient use the relaxation response (take a deep breath, exhale . long, and slow down) QUESTION 11 1. The PMHNP is working with a veteran who has posttraumatic stress disorder (PTSD). The PMHNP believes that dual awareness will be beneficial in allowing the patient to focus on the here and now. What strategies can the PMHNP use to develop dual awareness in the patient? 2. A Asking the patient to recall a recent and mildly disturbing event . B Having the patient focus on details of the room, such as how hot or cold it . is C Telling the patient to rate the level of disturbance he feels from a mildly . disturbing event D All of the above . QUESTION 12 1. Your patient is a 65-year-old male who has a strained relationship with his son and daughter. His children refuse to participate in a family session. The PMHNP asks the patient to draw his family genogram as a next step to . 2. A assess the patient’s mental health status and . functioning B explore the interpersonal styles of each family member . C provide background information for the patient’s family . structure D measure the patient’s quality of well-being and . productivity QUESTION 13 1. You are seeing a 29-year-old widow whose husband recently died overseas while serving his country in the military. She has been mourning the loss of her husband for several months, and continues to grieve. She refuses to go to group grieving sessions, but reports that she is still able to go to work and her fitness classes sometimes, and even makes attempts to stay social. She says, “Sometimes it’s like he’s not even gone. Other times it feels like it’s been an eternity since I’ve seen him. It’s hard to talk about this type of stuff with my girlfriends, especially since all of their husbands are still alive.” The PMHNP understands that it is appropriate to employ which therapeutic principle? 2. A Encouraging catharsis . B Encouraging abreaction to repressed . feelings C Identifying conflict-resolution . techniques D All of the above . QUESTION 14 1. A 65-year-old patient has suffered the loss of his wife. He is in a state of hyperarousal with increased sympathetic nervous system arousal. One or more interventions may help the patient to deal with this arousal. To decrease sympathetic nervous system arousal, the PMHNP’s treatment strategy is . 2. A mindfulness . techniques B deep breathing . exercises C self-regulation . strategies D all of the above . QUESTION 15 1. The PMHNP is caring for a patient who the PMHNP believes would benefit from a relational psychodynamic approach to therapy. Which action made by the PMHNP demonstrates appropriate use and understanding of the relationship psychodynamic model? 2. A Focusing the exploration on making the unconscious . conscious B Focusing the exploration on the genetic roots of the . patient’s problem C Focusing the exploration on here and now . D None of the above . QUESTION 16 1. 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: 2. A Observes and points out the behavior . B Stays quiet until the patient is ready to . speak C Brings in a colleague to help get the . patient to talk D None of the above . QUESTION 17 1. The patient is a 56-year-old female patient diagnosed with panic disorder and reports symptoms that include heart palpitations, frequent trembling, and feelings of choking in stressful situations. What special consideration does the PMHNP make? 2. A Using a special focus on transference as the agent . promoting change B Confronting the emotional significance of the patient’s . symptoms C Employing psychodynamic therapy combined with . pharmacotherapy D A and B . QUESTION 18 1. A 35-year-old patient seeks treatment for depression and anxiety after an abusive relationship. To help empower the patient, the PMHNP wants to teach the safe-place exercise to create a feeling of calm. In order to walk the patient through the exercise, the PMHNP first says: 2. A “Identify an image of a safe place that makes you . feel calm.” B “Think about the things that cause you anxiety and . let them go.” C “Take a deep breath and start to relax with each new . breath.” D “Picture a beautiful beach and describe to me what . you see.” QUESTION 19 1. The PMHNP is meeting with a 38-year-old divorced, single mother who has been seeing the PMHNP for anxiety and anger management. During one of the sessions, the patient tells the PMHNP that she is having a problem getting her child support payments from her ex-husband, which is triggering increased anxiety and anger, which she admittedly takes out on her children. How does the PMHNP respond in a way that upholds the supportive psychodynamic psychotherapy approach? 2. A Telling the patient to take a vacation to get away and relax . B Suggesting that she seek legal help . C Giving her advice about men and how to get them to pay . child support D Suggesting that the patient start going to church to help find . more solace. QUESTION 20 1. 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? 2. A “It is dangerous to fantasize about the future.” . B “I think that’s an excellent idea! I can help you review the . prerequisites!” C “You may want to explore the requirements for becoming a . PMNHP.” D None of the above. . QUESTION 21 1. The PMHNP meets with a 47-year-old male patient who is fearful of leaving the house after having witnessed his neighbor getting run over by a car. When the PMHNP asks why he is afraid to leave his house, the patient replies, “Because another accident might occur.” Which cognitive behavioral therapy (CBT) strategy does the PMHNP employ? 2. A Pharmacological . therapy B Stress inoculation . therapy C Dialectical behavior . therapy D All of the above