NRNP 6670 Final Exam Questions and Answers Latest Update 2023/2024 (Score A+)

NRNP 6670 Final Exam Questions Latest Update 2023/2024 (Score A+). Johanne is a 22-year-old female who is being treated for narcolepsy. She is attempting to implement a regimen of forced daytime naps in an effort to manage her condition without pharmacotherapy as she is generally averse to taking medications. While following Johanne, the PMHNP should be alert to signs and symptoms of: Suicidality Depressio n Hyperpha gia Disinhibiti on 1 points QUESTION 5 1. The PMHNP is asked to prepare a presentation for non-nursing health care workers in a local long-term care facility on the various causes of cognitive impairment in the elderly. A case presentation approach is used to reinforce principles of identifying delirium, which needs to be reported to the patient’s attending provider right away. The case should emphasize which of the following features as being closely correlated with delirium? Perceptual disturbances Rapid onset Agitation Abnormal sleep patterns 1 points QUESTION 6 1. Valerie is a 27-year-old woman who has been referred by her primary care provider. She was initially diagnosed with major depressive episode following a breakup with her boyfriend of 7 years. They moved into a house together 1 year ago, but within a few months the boyfriend moved out. Valerie was unresponsive to medication for depression and was referred to the mental health clinic. During this initial psychiatric evaluation, the PMHNP learns that a primary reason for the breakup was that Valerie had an extensive routine every night of repeatedly checking every door and window in the home to ensure that they were locked. Valerie’s nighttime routine is exhaustive and involves checking every door and window at least four times. She has a remote history of being attacked in her home while alone and states that she is unable to go to bed until she is certain that every door and window is locked. When considering diagnostic criteria for OCD, the PMHNP needs further assessment to ascertain which diagnostic criteria? The patient has tried unsuccessfully to suppress the urge to repeatedly check locks The compulsive activities are time-consuming to the extent that at least 1 hour daily is spent on them The disturbance is not better explained as the symptoms of another mental disorder The patient has good or fair insight with respect to the appropriateness of her behaviors 1 points QUESTION 7 1. Michael is an 18-year-old male who is presented to care at the urging of his parents. He has never had any significant medical or psychiatric problems in the past, but during his first semester at college he has developed a very alarming pattern of excess sleep. He is missing classes and is in danger of losing a scholarship. He is sleeping normally at night but apparently is having these very long episodes of napping and sleeping during the day. When he is awake, he tends to be rather withdrawn. His parents have taken him to their family practitioner as they thought he might be using drugs. A full exam, laboratory assessment, and toxicology screen are all normal, and there is no apparent cause for this sleepiness. While very rare, the PMHNP considers Kleine-Levin syndrome and further assesses for coincident onset of: Narcolepsy Mood disorder Hypersexua lity Alcohol abuse 1 points QUESTION 8 1. The primary differentiating feature between mild cognitive impairment (MCI) and Alzheimer’s dementia is: The presence of the apolipoprotein E4 gene Performance on objective neuropsychiatric testing Presence or absence of functional impairment Atrophy of the hippocampal volume 1 points QUESTION 9 1. Physiologic assessment of patients with paraphilias has demonstrated that most them have: Abnormal hormone levels Hard or soft neurological signs Chromosomal abnormalities Electroencephalogram (EEG) abnormalities 1 points QUESTION 10 1. Donna is a 41-year-old woman who is being evaluated at the request of her primary care provider for obsessive compulsive disorder. Which of the following aspects of Donna’s family medical history should prompt an immediate referral to a neurologist? Father committed suicide at age 38 Mother died from Huntington’s chorea Sister has temporal lobe epilepsy Brother has profound eczema 1 points QUESTION 11 1. With respect to the treatment of obsessive compulsive disorder, which of the following statements best characterizes the role of psychotherapy? Best treatment outcomes occur when patients combine psychotherapy with pharmacotherapy Psychotherapy is superior to behavior therapy as a nonpharmacologic adjunct to medications Psychodynamic exploration of a patient’s resistance to treatment may improve compliance to therapy There is no apparent benefit to psychotherapy in the management of obsessive compulsive disorder 1 points QUESTION 12 1. Jamal is a 31-year-old male who is being evaluated by the PMHNP as part of required care following a suicide attempt. He has never had mental health care before, but his history reveals a significant history of substance abuse. Upon further assessment, Jamal reveals that the reason he uses drugs and alcohol is that he becomes most aroused sexually when he dresses in women’s clothing. He is distressed by this. He says he is attracted to women, he is not gay, but he is just most aroused in this way. He admits that even when he was little, he was always drawn to his mother’s and sister’s clothing and underwear. Jamal’s condition is best characterized as: Gender dysphoria Intersex condition Sexual identity disorder Paraphilia 1 points QUESTION 13 1. The primary difference between sleepwalking and rapid eye movement behavior disorder (RBD) is that: Sleepwalkers do not have REM-mediated paralysis Sleepwalkers are acting on the dream imagery RBD patients do not respond to pharmacotherapy RBD may be due to a variety of brain abnormalities 1 points QUESTION 14 1. The PMHNP is preparing a community-based presentation for both the staff and residents of a local life-care facility. The facility offers a continuum of care from independent apartment living to assisted living to nursing home care. In an effort to increase awareness of signs and symptoms of dementia as compared to pseudodementia, the management has contracted with the PMHNP to prepare these informative educational programs. When comparing and contrasting these two conditions, the PMHNP emphasizes that in pseudodementia the patient is usually: Very aware of the dysfunction Afflicted by poor attention and concentration Good at concealing disability Joyful at accomplishing tasks 1 points QUESTION 15 1. Several medical disorders can produce symptoms of obsessive-compulsive disorder (OCD). Which of the following findings in a patient with new onset OCD should prompt an evaluation for a neurologic cause of symptoms? Family history of neurological disease Poorly controlled hypertension Age 40 at presentation Lack of response to SSRIs 1 points QUESTION 16 1. Which of the following is a true statement with respect to obsessive-compulsive disorder? Most clinical drug trials support the hypothesis that dysregulation of the serotonergic system is involved in symptom formation Between 50 and 75% of patients with obsessive-compulsive disorder (OCD) had premorbid obsessive-compulsive personality disorder (OCPD) Behavioral theory suggests that development of obsessive thoughts and compulsive behaviors are a result of respondent conditioning Most affected individuals are diagnosed between the ages of 25 and 40 1 points QUESTION 17 1. Joyce is a 30-year-old female patient who was recently diagnosed with schizophrenia after being referred for mental health evaluation by the police. She demonstrated paranoid delusions that ultimately led to such disruptive behavior at her place of work that the police were called. Her husband was able to provide a history consistent with prodromal symptoms, and in retrospect her disorganized thought and poor insight were evident over the last few months. She was initially stabilized on IM Zyprexa (olanzapine) and has been maintained on oral Zyprexa for the last 2 weeks, and has been on 10 mg daily for 1 week. Today at followup she demonstrates mild improvement. Her hygiene and appearance are much improved. She is still hearing voices and has delusions that communists are trying to infiltrate the company for which she works. She is open to the idea that these are delusions but still seems hesitant to accept that premise. At this point her medication management should include: Obtaining an olanzapine level Increasing the dose of Zyprexa Cross titrate another antipsychotic Add a mood stabilizer 1 points QUESTION 18 1. Recurrent isolated sleep paralysis is characterized by the awareness of normal REMmediated paralysis in the partially conscious state. It is a feature of normal REM sleep, and lifetime occurrence is estimated to be as high as 50%. While counseling patients about this condition, the PMHNP correctly states all the following except: First-line therapy includes ensuring adequate sleep Shift work can increase the likelihood that this occurs People experience this should not be touched It is among the tetrad of narcolepsy symptoms 1 points QUESTION 19 1. A wide variety of sleep-wake disorders are referred to the PMHNP for assessment and management. A contemporary approach to managing insomnia centers around: Diagnosing and managing underlying causation Providing relief and managing symptoms Focusing on nonpharmacologic therapies Differentiating “tiredness” from “sleepiness” 1 points QUESTION 20 1. Trudy is a 49-year-old woman recently diagnosed with schizophrenia. While she has a strong family history of mood disorders, and has herself evidenced some depressive symptoms by history, her delusions and diagnosis of schizophrenia were a big surprise to herself and her family. She has been married for 25 years and by all accounts has had a successful marriage and family life until the last few months when she became increasingly concerned that her best friend was trying to seduce her husband. Further history suggests that she has paranoid delusions and that her memos from work carried messages that her coworkers were trying to destroy her family. Trudy was finally referred for care when she tried to attack a coworker. There is no apparent precipitating factor, and her family cannot understand why she is just now demonstrating symptoms of schizophrenia. Now that she is in treatment, which elements of her history support a good prognosis? Lack of precipitating factors Neurological signs Physical assault Age of onset 1 points QUESTION 21 1. Shireen is a 21-year-old transgender female who has been through an exhaustive counseling program and is ready to start hormone therapy with estrogen, progesterone, and testosterone-blocking agents. When counseling her specifically about the risks, benefits, and required monitoring of hormonal therapy, the PMHNP advises Shireen that: Her ability to conceive will not be adversely impacted There is a significant risk of developing benign prolactinomas Smoking cigarettes while on estrogen therapy increases risk of thrombosis If breast augmentation is planned, it should be performed prior to hormone therapy 1 points QUESTION 22 1. John is a 20-year-old male who is referred to treatment by his father. The two of them live together following the murder of John’s mother 6 weeks ago. It was a tragic occurrence; John’s mother was a nurse at an inner-city hospital and was killed as an innocent bystander in a drive-by shooting. John was very close to his mother, and in the last 3 weeks he has been increasingly distraught. His dad says he did not cope well from the beginning, but for the last 2 weeks he has been agitated, combative, and is hearing voices telling him that he could have saved his mother. He has become so agitated that his father brought him to the emergency room. The PMHNP knows that immediate treatment for John should include: Electroconvulsive therapy IM antipsychotics Benzodiazepines Antidepressants 1 points QUESTION 23 1. Gerry is a 24-year-old male who is being evaluated for obsessive-compulsive disorder (OCD). He has a long history of both obsessive thoughts and compulsive behaviors going back into mid-adolescence. When evaluating his history, the PMHNP knows that all of the following are more common in patients with OCD except: Celibacy Tourette’s disorder Marital discord Obsessive-compulsive personality disorder 1 points QUESTION 24 1. Schizophrenia, schizoaffective disorder, and schizophreniform disorder are all among the continuum of psychiatric illnesses characterized by psychotic episodes. Which of the following clusters of features best distinguishes schizophreniform disorder? Prodrome of negative symptoms, duration 1 month, early age of onset Absence of mood disorder, two or more psychotic symptoms, duration 6 months Progressive decline in social and occupational function, insidious onset, complete resolution of symptoms Rapid and acute onset, return to baseline in 6 months, occurs in adolescents and young adults 1 points QUESTION 25 1. Danny is a 19-year-old male who presents to the college mental health center at the insistence of his roommate. Danny has developed what his roommate calls an obsession with cleanliness. He showers several times a day and changes his clothes easily four or five times. He also brushes his teeth every couple of hours, convinced that he has bad breath. During the interview, it does not appear that these are anxiety-reducing rituals but rather he is certain that he has unpleasant body odors and needs to keep showering and brushing his teeth to get rid of them. While considering a diagnosis of obsessive-compulsive disorder, the PMHNP considers that differential diagnoses for Danny include all the following except: Olfactory reference syndrome Obsessive compulsive personality disorder Temporal lobe epilepsy Sinus inflammation 1 points QUESTION 26 1. Sarah is a 52-year-old female who is referred to psychiatric care by her primary care provider. Sarah clearly does not feel that the evaluation is necessary and indicates that she has essentially been “blackmailed” by her long-time primary care provider who says he will no longer see Sarah until she has a mental health assessment. The referring PCP reports that Sarah is convinced that she has a cancer that he cannot diagnose. Sarah’s mother, brother, and sister all died from various cancers, and Sarah has become convinced that she has one too, although no one can find it. A genetic evaluation indicates no genetic or familial risk. Sarah has had a thorough physical examination; been screened for colorectal, breast, and cervical cancer; and has also had CT scans of the head and chest; the last two at her request as her mother and brother had brain and lung cancer, respectively. Sarah has no specific symptoms but is fixed in the belief that she has cancer that no one can find. When considering a diagnosis of delusional disorder, the PMHNP would expect Sarah’s evaluation to reveal: Mental status examination is normal Hallucinations consistent with occult cancer A willingness to consider objective evidence that her belief is unrealistic Family history of psychotic or mood disorder 1 points QUESTION 27 1. Obsessive compulsive disorder is characterized by variable success to treatment, presenting on a bell-curve continuum. Twenty to 30% of patients have significant improvement, 40–50% have moderate improvement, and 20–40% remain ill or even develop worsening symptoms. Which of the following is best correlated with the most optimistic treatment outcomes? Childhood onset Yielding to compulsions Precipitating event Some acceptance of symptoms 1 points QUESTION 28 1. Which of the following infectious diseases associated with psychiatric symptoms is most likely to present with olfactory and gustatory hallucinations, psychosis, personality changes, and partial seizures? Rabies encephalitis Neurosyphilis Lyme disease