BARKLEY PMHNP Pract.. ONE EXAMINATION [questuion
and answers ]A+
1. 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.: 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.
2. 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.: 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?
,BARKLEY PMHNP Pract.. ONE EXAMINATION [questuion
and answers ]A+
1.Borderline personality disorder
2.Oppositional defiant disorder
3.Adjustment disorder with disturbance of conduct
4.Bipolar disorder
3. 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.: 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
4. 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.: 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.
,BARKLEY PMHNP Pract.. ONE EXAMINATION [questuion
and answers ]A+
5.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).: 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
6. 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
, BARKLEY PMHNP Pract.. ONE EXAMINATION [questuion
and answers ]A+
effects.: 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
7. 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.: 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.
8. 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
and answers ]A+
1. 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.: 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.
2. 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.: 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?
,BARKLEY PMHNP Pract.. ONE EXAMINATION [questuion
and answers ]A+
1.Borderline personality disorder
2.Oppositional defiant disorder
3.Adjustment disorder with disturbance of conduct
4.Bipolar disorder
3. 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.: 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
4. 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.: 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.
,BARKLEY PMHNP Pract.. ONE EXAMINATION [questuion
and answers ]A+
5.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).: 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
6. 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
, BARKLEY PMHNP Pract.. ONE EXAMINATION [questuion
and answers ]A+
effects.: 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
7. 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.: 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.
8. 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
