BARKLEY PMHNP Pract.. ONE
Although the patient may be rationalizing her behavior as a righteous act, patients with kleptomania do
not commit theft to express anger or vengeance. Kleptomania is characterized as failing to resist the
impulse to steal, and the stolen objects are typically not needed. The act of stealing, which usually is
performed alone, gives the person gratification. - (correct Answer) - Harriet is a well-established business
woman who provides for her family. She was recently arrested for stealing over $10,000 worth of
merchandise from the mall. When Harriet is asked to describe her behavior, she says: "It just comes on
me quickly, and when it's done, I feel really good." She also describes how she grew up poor and sees
the theft as a way to "even the score" against those with "empty wealth." Which of the following does
not meet the diagnostic criteria for kleptomania?
Harriet views her shoplifting as a righteous act.
Harriet's stealing is described as pleasurable.
Harriet is well-off and can support her family's needs.
Harriet's stealing is described as impulsive.
Borderline personality disorder is not considered a differential diagnosis for conduct disorder, as
indicated by the patient's truancy, defiance of authority figures, fights with family members, poor
academic performance, sexual promiscuity, running away from home, and "tough guy" demeanor.
Oppositional defiant disorder, bipolar disorders, and adjustment disorders are all considered potential
differential diagnoses for conduct disorder, as are depressive disorders, attention-deficit/hyperactivity
disorder, and intermittent explosive disorder. - (correct Answer) - Tony, a 16-year-old male, has been sent
to your clinic for counseling. He has a long record of skipping school, talking back to his teachers, and
getting poor grades. His parents say he has often gotten in fights with them, has frequently been caught
sneaking girls into his room, and has run away from home on two occasions. During the session, you
notice Tony acts tough and aloof, not deigning to speak much. If you suspect conduct disorder, which of
the following conditions would you be least likely to include in your differential diagnosis?
1. Borderline personality disorder
2. Oppositional defiant disorder
3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder
Depressive symptoms are associated with decreased, not increased, levels of somatostatin in
cerebrospinal fluid. Patients with depression may exhibit a decreased thyroid-stimulating hormone
response to thyrotropin-releasing hormone, as well as hypersecretion of cortisol. Depressive symptoms
are also associated with irregularities in growth hormone release, such as reduced nocturnal secretion
and diurnal hypersecretion. - (correct Answer) - Which of these lab findings would be least expected in a
patient with depression?
1. Decreased nocturnal growth hormone secretion
,2. Decreased thyroid-stimulating hormone response
3. Increased somatostatin in cerebrospinal fluid
4. Increased secretion of cortisol
Although ambivalence regarding suicidal intent should be taken into account when considering level of
observation in a patient, it indicates a moderate risk, not a severe risk. Close observation should be
employed with patients who profess suicidal thoughts, are unable to commit to a "No Harm" contract, or
experience withdrawal. - (correct Answer) - Jeremy, a suicidal inpatient, is under close observation. He is
able to be observed at all times by hospital staff during waking hours and when he sleeps, and is checked
on every 15-30 minutes. Which of these reasons would least indicate the need for this level of
supervision?
1. Jeremy has expressed suicidal thoughts.
2. Jeremy experiences withdrawal from alcohol and cocaine.
3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract.
The patient's recent involvement in risky pleasurable activity (e.g., unprotected sex), increase in goal-
driven activity at work, decreased need for sleep, and subjective experience of racing thoughts all
suggest a manic episode; as such, bupropion, an antidepressant, would not be considered because the
patient has not displayed the diagnostic criteria for a major depressive episode. Pharmacologic options
for the treatment of manic episodes include anticonvulsants (carbamazepine), antipsychotics
(haloperidol), and benzodiazepines (lorazepam). - (correct Answer) - Adam, a 23-year-old male, is
undergoing an STD test at your clinic. When you ask him why he is here, he says, "I'm here because I've
had this increased craving for sex. I've been picking up strangers in bars, not caring about using
protection ... I don't know what it is. For the last week, I've just felt really driven. Keep throwing myself
into my work, don't feel much need for sleep, feel like my thoughts are running a marathon in my head."
The patient lives a "clean life," clarifying that he does not abuse any substance, "not even coffee or
cigarettes." He also does not have a history of mental disorders. Given the most likely diagnosis, which of
these medications would you least likely recommend for Adam?
Lorazepam
Haloperidol
Carbamazepine
Bupropion
Lorazepam would not be the first choice to treat delirium in a dehydrated patient because
benzodiazepines may cause respiratory depression, especially in debilitated patients. Antipsychotics such
as haloperidol, quetiapine, and risperidone are considered the mainstay in managing agitation in
delirium patients; haloperidol is considered the standard of care, but newer agents such as quetiapine
and risperidone may be preferred due to reduced chance of side effects. - (correct Answer) - You have
determined that a patient's delirium stems from dehydration. As you begin treatment, you realize the
,patient will require pharmacologic management for his agitation. Which of these agents would be least
appropriate in this situation?
Risperidone
Haloperidol
Quetiapine
Lorazepam
Most inpatients who develop a suicide plan and follow it have agreed to a "No Harm" contract. The most
common method of suicide among inpatients is hanging, not self-inflicted wounds. When "unsolvable"
problems at work, school, or home motivate the ideation, inpatients are most likely to attempt suicide
either within the first 5 days at the hospital or shortly after discharge, not after a month. The rate of
suicide among bipolar patients is relatively low, about 10%-15%, and risk would be higher in patients
with schizophrenia or an untreated anxiety disorder. - (correct Answer) - Which of the following is true
about suicide among inpatients?
Most patients who develop a suicide plan and follow it have agreed to a "No Harm" contract.
Self-inflicted wounds are the most common means of suicide.
Inpatients with bipolar disorder are most likely to commit suicide.
Patients who attempt suicide due to "unsolvable" problems usually do so after a month in care.
Auditory hallucinations, loss of memory, and lack of personal hygiene are all markers of the acute phase
of schizophrenia. Other signs and symptoms of this stage include illogical thinking, inappropriate social
behavior, catatonic excitement, and poor concentration. The premorbid phase is indicated by depression,
sleep disturbance, and bedwetting. The prodromal phase is characterized by suspiciousness,
inappropriate expression of feeling, and feelings of unreality. Lastly, the stable phase is symptomatically
similar to the prodromal phase. - (correct Answer) - Cam, a 23-year-old female, is brought to the hospital
by her boyfriend. He states that she has been hearing voices, cannot remember anything, and refuses to
take a shower or change her clothes. He adds, "She used to be a very clean person and had a really good
memory." Which phase of schizophrenia is Cam most likely experiencing?
Premorbid phase
Prodromal phase
Stable phase
Acute phase
Although many patients have a demographic preference for their primary care provider, merely asking if
the patient believes that you "will help him" would not provide information regarding his general health
beliefs. The statement would more likely provide an opinion based solely on the patient's perception of
the nurse practitioner (NP). Asking about the patient's attitude regarding disability and illness,
preventative health practices, and taboos and cultural attitudes with regards to modesty and special
procedures would all yield beneficial information to help the NP understand the patient's beliefs about
, health and healthcare. - (correct Answer) - Leon presents to the clinic with findings suggestive of bipolar
disorder. As Leon is a recent immigrant from Haiti, you begin by giving him a cultural assessment. Which
of the following questions would be least helpful in gaining information about Leon's health beliefs and
practices?
"How do you generally try to stay healthy?"
"Do you believe that I will help you feel better?"
"What do you think a mental disorder says about a person?"
"Do you have any issues with undressing for an assessment?"
Multisystemic therapy is a rehabilitation model aimed at treating children and adolescents with serious
mental illness; under this model, parents and teachers are taught skills to manage mental disorders so
that the patient does not need to be removed from the community for hospitalization. Multisystemic
therapy is not aimed at adults and does not directly focus on community reintegration or finding
employment. - (correct Answer) - Which of these patients would most likely receive rehabilitation under
the multisystemic therapy model?
A 32-year-old female who has completed inpatient treatment for schizophrenia
A 16-year-old male undergoing treatment for bipolar disorder
A 63-year-old female diagnosed with frontotemporal neurocognitive disorder
A 27-year-old male with major depressive disorder seeking employment
When initiating a schizophrenia patient on clozapine, the patient should be instructed to titrate daily
dosage by 25-50 mg to a target dosage of 300-450 mg/day, rather than 600-900 mg/day, and a single
dose should never exceed 450 mg. The maximum allowable daily dose is 900 mg/day, but this dosage
should not be targeted until the patient has reached a targeted daily dose of 300-450 mg/day. The
patient should also be instructed to return for weekly complete blood count to monitor white blood
count in order to prevent agranulocytosis. - (correct Answer) - Clozapine use requires rigorous dosing
and monitoring in patients. Which of the following is the proper instruction for a patient being initiated
on clozapine therapy for schizophrenia?
Initiate therapy with a 6-mg dose, followed by a 12.5-mg dose
Instruct the patient to return weekly for a complete blood count to monitor red blood cell levels
Titrate daily dosage by 25-50 mg/day, as tolerated, to target dosage of 600-900 mg/day
Dosage should never exceed 450 mg at one time
Although a fine hand tremor is a potential side effect of therapeutic use of lithium, a coarse hand tremor
is suggestive of lithium toxicity. Diarrhea and other gastrointestinal complications may occur with toxicity
but are expected with normal doses of lithium. Other side effects associated with therapeutic use of
lithium include polyuria, dermatologic disturbances, polydipsia, and weight gain. - (correct Answer) -
Which of these side effects would be of greatest concern for a patient taking lithium?
Although the patient may be rationalizing her behavior as a righteous act, patients with kleptomania do
not commit theft to express anger or vengeance. Kleptomania is characterized as failing to resist the
impulse to steal, and the stolen objects are typically not needed. The act of stealing, which usually is
performed alone, gives the person gratification. - (correct Answer) - Harriet is a well-established business
woman who provides for her family. She was recently arrested for stealing over $10,000 worth of
merchandise from the mall. When Harriet is asked to describe her behavior, she says: "It just comes on
me quickly, and when it's done, I feel really good." She also describes how she grew up poor and sees
the theft as a way to "even the score" against those with "empty wealth." Which of the following does
not meet the diagnostic criteria for kleptomania?
Harriet views her shoplifting as a righteous act.
Harriet's stealing is described as pleasurable.
Harriet is well-off and can support her family's needs.
Harriet's stealing is described as impulsive.
Borderline personality disorder is not considered a differential diagnosis for conduct disorder, as
indicated by the patient's truancy, defiance of authority figures, fights with family members, poor
academic performance, sexual promiscuity, running away from home, and "tough guy" demeanor.
Oppositional defiant disorder, bipolar disorders, and adjustment disorders are all considered potential
differential diagnoses for conduct disorder, as are depressive disorders, attention-deficit/hyperactivity
disorder, and intermittent explosive disorder. - (correct Answer) - Tony, a 16-year-old male, has been sent
to your clinic for counseling. He has a long record of skipping school, talking back to his teachers, and
getting poor grades. His parents say he has often gotten in fights with them, has frequently been caught
sneaking girls into his room, and has run away from home on two occasions. During the session, you
notice Tony acts tough and aloof, not deigning to speak much. If you suspect conduct disorder, which of
the following conditions would you be least likely to include in your differential diagnosis?
1. Borderline personality disorder
2. Oppositional defiant disorder
3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder
Depressive symptoms are associated with decreased, not increased, levels of somatostatin in
cerebrospinal fluid. Patients with depression may exhibit a decreased thyroid-stimulating hormone
response to thyrotropin-releasing hormone, as well as hypersecretion of cortisol. Depressive symptoms
are also associated with irregularities in growth hormone release, such as reduced nocturnal secretion
and diurnal hypersecretion. - (correct Answer) - Which of these lab findings would be least expected in a
patient with depression?
1. Decreased nocturnal growth hormone secretion
,2. Decreased thyroid-stimulating hormone response
3. Increased somatostatin in cerebrospinal fluid
4. Increased secretion of cortisol
Although ambivalence regarding suicidal intent should be taken into account when considering level of
observation in a patient, it indicates a moderate risk, not a severe risk. Close observation should be
employed with patients who profess suicidal thoughts, are unable to commit to a "No Harm" contract, or
experience withdrawal. - (correct Answer) - Jeremy, a suicidal inpatient, is under close observation. He is
able to be observed at all times by hospital staff during waking hours and when he sleeps, and is checked
on every 15-30 minutes. Which of these reasons would least indicate the need for this level of
supervision?
1. Jeremy has expressed suicidal thoughts.
2. Jeremy experiences withdrawal from alcohol and cocaine.
3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract.
The patient's recent involvement in risky pleasurable activity (e.g., unprotected sex), increase in goal-
driven activity at work, decreased need for sleep, and subjective experience of racing thoughts all
suggest a manic episode; as such, bupropion, an antidepressant, would not be considered because the
patient has not displayed the diagnostic criteria for a major depressive episode. Pharmacologic options
for the treatment of manic episodes include anticonvulsants (carbamazepine), antipsychotics
(haloperidol), and benzodiazepines (lorazepam). - (correct Answer) - Adam, a 23-year-old male, is
undergoing an STD test at your clinic. When you ask him why he is here, he says, "I'm here because I've
had this increased craving for sex. I've been picking up strangers in bars, not caring about using
protection ... I don't know what it is. For the last week, I've just felt really driven. Keep throwing myself
into my work, don't feel much need for sleep, feel like my thoughts are running a marathon in my head."
The patient lives a "clean life," clarifying that he does not abuse any substance, "not even coffee or
cigarettes." He also does not have a history of mental disorders. Given the most likely diagnosis, which of
these medications would you least likely recommend for Adam?
Lorazepam
Haloperidol
Carbamazepine
Bupropion
Lorazepam would not be the first choice to treat delirium in a dehydrated patient because
benzodiazepines may cause respiratory depression, especially in debilitated patients. Antipsychotics such
as haloperidol, quetiapine, and risperidone are considered the mainstay in managing agitation in
delirium patients; haloperidol is considered the standard of care, but newer agents such as quetiapine
and risperidone may be preferred due to reduced chance of side effects. - (correct Answer) - You have
determined that a patient's delirium stems from dehydration. As you begin treatment, you realize the
,patient will require pharmacologic management for his agitation. Which of these agents would be least
appropriate in this situation?
Risperidone
Haloperidol
Quetiapine
Lorazepam
Most inpatients who develop a suicide plan and follow it have agreed to a "No Harm" contract. The most
common method of suicide among inpatients is hanging, not self-inflicted wounds. When "unsolvable"
problems at work, school, or home motivate the ideation, inpatients are most likely to attempt suicide
either within the first 5 days at the hospital or shortly after discharge, not after a month. The rate of
suicide among bipolar patients is relatively low, about 10%-15%, and risk would be higher in patients
with schizophrenia or an untreated anxiety disorder. - (correct Answer) - Which of the following is true
about suicide among inpatients?
Most patients who develop a suicide plan and follow it have agreed to a "No Harm" contract.
Self-inflicted wounds are the most common means of suicide.
Inpatients with bipolar disorder are most likely to commit suicide.
Patients who attempt suicide due to "unsolvable" problems usually do so after a month in care.
Auditory hallucinations, loss of memory, and lack of personal hygiene are all markers of the acute phase
of schizophrenia. Other signs and symptoms of this stage include illogical thinking, inappropriate social
behavior, catatonic excitement, and poor concentration. The premorbid phase is indicated by depression,
sleep disturbance, and bedwetting. The prodromal phase is characterized by suspiciousness,
inappropriate expression of feeling, and feelings of unreality. Lastly, the stable phase is symptomatically
similar to the prodromal phase. - (correct Answer) - Cam, a 23-year-old female, is brought to the hospital
by her boyfriend. He states that she has been hearing voices, cannot remember anything, and refuses to
take a shower or change her clothes. He adds, "She used to be a very clean person and had a really good
memory." Which phase of schizophrenia is Cam most likely experiencing?
Premorbid phase
Prodromal phase
Stable phase
Acute phase
Although many patients have a demographic preference for their primary care provider, merely asking if
the patient believes that you "will help him" would not provide information regarding his general health
beliefs. The statement would more likely provide an opinion based solely on the patient's perception of
the nurse practitioner (NP). Asking about the patient's attitude regarding disability and illness,
preventative health practices, and taboos and cultural attitudes with regards to modesty and special
procedures would all yield beneficial information to help the NP understand the patient's beliefs about
, health and healthcare. - (correct Answer) - Leon presents to the clinic with findings suggestive of bipolar
disorder. As Leon is a recent immigrant from Haiti, you begin by giving him a cultural assessment. Which
of the following questions would be least helpful in gaining information about Leon's health beliefs and
practices?
"How do you generally try to stay healthy?"
"Do you believe that I will help you feel better?"
"What do you think a mental disorder says about a person?"
"Do you have any issues with undressing for an assessment?"
Multisystemic therapy is a rehabilitation model aimed at treating children and adolescents with serious
mental illness; under this model, parents and teachers are taught skills to manage mental disorders so
that the patient does not need to be removed from the community for hospitalization. Multisystemic
therapy is not aimed at adults and does not directly focus on community reintegration or finding
employment. - (correct Answer) - Which of these patients would most likely receive rehabilitation under
the multisystemic therapy model?
A 32-year-old female who has completed inpatient treatment for schizophrenia
A 16-year-old male undergoing treatment for bipolar disorder
A 63-year-old female diagnosed with frontotemporal neurocognitive disorder
A 27-year-old male with major depressive disorder seeking employment
When initiating a schizophrenia patient on clozapine, the patient should be instructed to titrate daily
dosage by 25-50 mg to a target dosage of 300-450 mg/day, rather than 600-900 mg/day, and a single
dose should never exceed 450 mg. The maximum allowable daily dose is 900 mg/day, but this dosage
should not be targeted until the patient has reached a targeted daily dose of 300-450 mg/day. The
patient should also be instructed to return for weekly complete blood count to monitor white blood
count in order to prevent agranulocytosis. - (correct Answer) - Clozapine use requires rigorous dosing
and monitoring in patients. Which of the following is the proper instruction for a patient being initiated
on clozapine therapy for schizophrenia?
Initiate therapy with a 6-mg dose, followed by a 12.5-mg dose
Instruct the patient to return weekly for a complete blood count to monitor red blood cell levels
Titrate daily dosage by 25-50 mg/day, as tolerated, to target dosage of 600-900 mg/day
Dosage should never exceed 450 mg at one time
Although a fine hand tremor is a potential side effect of therapeutic use of lithium, a coarse hand tremor
is suggestive of lithium toxicity. Diarrhea and other gastrointestinal complications may occur with toxicity
but are expected with normal doses of lithium. Other side effects associated with therapeutic use of
lithium include polyuria, dermatologic disturbances, polydipsia, and weight gain. - (correct Answer) -
Which of these side effects would be of greatest concern for a patient taking lithium?
