NURS 6640 Midterm Exam – Questions With Answers 2023/2024 (Graded A+)

NURS 6640 Midterm Exam – Questions With Answers 2023/2024 (Graded A+). A PMHNP is caring for a 21-year-old woman who is suffering from anxiety and is having difficulty managing stress. Which of the following would be an appropriate step by the PMHNP? A. Asking the patient what she does to relieve anxiety B. Giving the patient basic stress management activities C. Developing a plan together that is not overwhelming D. All of the above D 1 points QUESTION 2 1. The PMHNP is working with a 56-year-old man who is being seen because of his anxiety and depression. During the therapy sessions, the PMHNP assists the patient in discussing his experiences and expanding on his thoughts and feelings. He tells the PMHNP stories about how he used to be teased by his coworkers at the office for becoming too anxious in large conference rooms. The PMHNP listens to the patient and helps focus on his strengths to promote self-understanding. Which principle best accounts for the PMHNP‟s interactions with the patient? A. Therapeutic communication B. Maintaining the frame C. Working with resistance D. None of the above A 1 points QUESTION 3 1. 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? A. Interview the patient‟s family members B. Construct a timeline of the patient‟s life C. Review the patient‟s current stressors Debrief with the patient B 1 points QUESTION 4 1. One of the strategies the PMHNP wants to try includes sleep restriction. What will the PMHNP suggest to follow sleep restriction therapy? A. “Restrict sleep for 24 hours.” 2 B. “Restrict the amount of time you spend in bed.” C. “Restrict the amount of exercise you do prior to going to bed.” D. “Restrict the amount of food you eat before bedtime.” B 1 points QUESTION 5 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 True 1 points QUESTION 6 1. 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? A. Young Mania Rating Scale B. Hamilton Anxiety Rating Scale C. Dissociative Experiences Scale D. Impact of Event Scale D 1 points QUESTION 7 1. The PMHNP is caring for a patient who seems to seek affection and attention from the PMHNP and others in the clinic, as well as displays heightened emotional responses to feelings of being excluded. What therapeutic approach does the PMHNP use to decrease autonomic arousal in the patient? A. Group therapy B. Controlled confrontation C. A safe-place exercise D. Body and energy work C 1 points QUESTION 8 3 1. A PMHNP is assessing ego functioning of his 40-year-old patient by asking what she feels is the cause of her problems. She attributes her problems to her overprotective parents not letting her have enough freedom growing up. Based on her answer, the PMHNP is testing _____________. A. adaptive regression in the service of the ego B. regulation and control of affects and impulses C. defensive and interpersonal functioning D. sense of reality of the world and of the self C 1 points QUESTION 9 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: 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.” A 1 points QUESTION 10 1. 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? A. Revise intake forms to align with state laws B. Review confidentiality revisions with patients C. Have patients give informed consent again D. All of the above 1 points QUESTION 11 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? 4 A. Remaining quiet until the child is ready to talk B. Using communication techniques that are expressive C. Inviting the child‟s parents to speak on behalf of the child D. All of the above 1 points QUESTION 12 1. 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? A. “I typically don‟t listen to anyone. I take care of my own wants and needs so I feel like no one can judge me or criticize me, period.” B. “I don‟t mean to hurt other people‟s feelings. When people cry or say that I have made them upset in some way, that‟s not my fault; some people are just sensitive.” C. “I like to listen to the beat of my own drum; I don‟t mind spending most of my days alone. I don‟t need recognition or praise; I would just like to be left alone.” 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.” 1 points QUESTION 13 1. During a therapy session with an 18-year-old female the PMHNP learns that she has lived in six different foster homes in the last 24 months. She states that her mother is in a correctional facility for drug abuse and prostitution. During the assessment, the PMHNP notices multiple superficial cuts to each wrist. The patient appears tearful, withdrawn, and never makes direct eye contact. The PMHNP believes that this patient may have feelings of insecurities as well as abandonment issues and is aware that which diagnosis is likely possible? A. Narcissistic personality disorder B. Obsessive-compulsive personality disorder C. Borderline personality disorder D. Paranoid personality disorder 1 points QUESTION 14 5 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? A. Eat a heavy meal before bedtime to induce sleepiness B. Maintain a warm bedroom temperature C. Avoid watching television or reading in bed D. Try going to sleep at different times throughout the week to avoid monotony 1 points QUESTION 15 1. 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? A. Emphasize the past B. Focus on expressions of emotion C. Identify patterns in relationships D. All of the above 1 points QUESTION 16 1. 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? A. Responding to the patient in a nondefensive manner and accepting responsibility for the PMHNP‟s part in the tension B. Emphasizing with the patient‟s experiences and validating the patient for bringing it up C. Considering changing the goals of the patient‟s treatment D. All of the above 1 points QUESTION 17 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: A. Developing increased boundaries B. Decreasing supportive psychotherapy C. Scaling back contact with the patient D. Increasing the number of sessions per week 1 points QUESTION 18 6 1. The PMHNP is working with a patient who has dissociative disorder and requests pharmacological interventions for dealing with her trauma. What education does the PMHNP provide to the patient regarding medication therapy? A. “The medication will help you forget the things that trigger your flashbacks.” B. “The medication takes a while to build up in your system and cure you.” C. “The medication may provide symptom relief, but you still need psychotherapy.” D. All of the above. 1 points QUESTION 19 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? 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 1 points QUESTION 20 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 ___________. A. mindfulness techniques B. deep breathing exercises C. self-regulation strategies D. all of the above 1 points QUESTION 21 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? 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 1 points QUESTION 22 7 1. The PMHNP is working with a 43-year-old male patient who develops idiosyncratic transference over weeks of therapy. The best way for the PMHNP to respond to this patient is to ___________: A. employ cognitive behavioral therapy B. use empathy C. utilize intersubjectivity D. none of the above 1 points QUESTION 23 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? 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) 1 points QUESTION 24 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? 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 1 points QUESTION 25 1. The PMHNP is working with a patient who experiences abreactions when discussing repressed feelings of his sexual abuse as a child. What can the PMHNP do to manage the patient‟s intense emotional reactions? A. Sit closer to the patient so the patient does not feel isolated B. Embrace the patient to provide physical comfort C. Suggest a relaxation technique, such as yoga or meditation D. All of the above 1 points 8 QUESTION 26 1. 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 self-references 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 ____________. A. will require more processing strategies B. would benefit from the stabilization stage C. is ready to move to Stage III, future visioning D. no longer needs to continue with therapy 1 points QUESTION 27 1. 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? A. Assure the patient that she is safe to discuss her secrets B. Talk about the importance of being truthful and open C. Have a discussion about the confidentiality and its limits D. Mention the possible need for selective self-disclosure 1 points QUESTION 28 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? A. “Are Joel‟s peers including him at recess?” B. “Does Joel feel safe and secure at school?” C. “Is Joel getting enough sleep at home?” D. “How can Joel feel that he is loved?” 1 points QUESTION 29 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? 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. 9 1 points QUESTION 30 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? A. Pharmacological therapy B. Stress inoculation therapy C. Dialectical behavior therapy D. All of the above 1 points QUESTION 31 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 _______________. 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