6670 FINAL EXAM
QUESTION 1
1. Collette is a 23-year-old female who presented for emergency care with her mother
because her behavior has become increasingly erratic and caused her to lose her job. Her
mother reports that she had never done anything like this in the past, but about 3 months
ago, her boyfriend of 3 years broke up with her, and Collette began to express unrealistic
beliefs that her boyfriend wanted to drive her crazy and hurt her. A gentleman trying to hail
a taxi accidentally bumped into her this morning, and she started screaming that her ex-
boyfriend had hired the man to throw her into the street under a car. Collette is on a 2-week
suspension from her job as a restaurant server because she was combative to a customer—
she accused him of colluding with her ex-boyfriend to get her fired. After this morning’s
incident, her mother was so worried she brought her to the emergency room. Her
appearance is disheveled, she is clearly hyperalert and is crying that her boyfriend must
have converted her mother to work against her. Head imaging, screening lab, and a
toxicology screen are negative. A leading differential for Collette is:
Bipolar disorder
Acute psychotic episode
Schizophreniform disorder
Post-traumatic stress disorder
1 points
QUESTION 2
1. Jake and Laurie are a young married couple who have been referred to mental health
counseling because Jake is having disturbing sleep events. Laurie reports that on more than
one occasion she has awakened to find Jake having what appears to be a panic attack, but
he doesn’t seem to realize it. When he finally wakes up, he is confused and doesn’t really
understand what happened, although he does have a sense of intense fear. This has
happened twice in the last 2 weeks, and the last time Laurie heard him screaming. Jake is
now a bit afraid to go to sleep and as a result does not feel well the next day. The PMHNP
recognizes that sleep terrors in adults:
Are often associated with trauma or
psychiatric problems
Represent a disorder of REM sleep
, May be a symptom of temporal lobe epilepsy
Is treated with a cycle of sleep deprivation
1 points
QUESTION 3
1. Jack is a 27-year-old male who has a history of paranoid schizophrenia that first
became apparent approximately 10 years ago. He developed paranoid delusions and
eventually decompensated to the point that he required inpatient stabilization. At the time,
he was started on conventional antipsychotics, but due to intolerable adverse effects he was
switched to haloperidol. It worked well, but whenever he stopped taking it, symptoms would
recur. After several hospitalizations, he was stabilized. The neurophysiologic theory of
schizophrenia suggests that Jack’s symptoms were a result of:
Increased dopamine activity in the
mesolimbic pathway
Increased dopamine activity in the
mesocortical pathway
Increased glutamate in the prefrontal cortex
Increased glutamate in the hippocampus
1 points
QUESTION 4
1. 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
QUESTION 1
1. Collette is a 23-year-old female who presented for emergency care with her mother
because her behavior has become increasingly erratic and caused her to lose her job. Her
mother reports that she had never done anything like this in the past, but about 3 months
ago, her boyfriend of 3 years broke up with her, and Collette began to express unrealistic
beliefs that her boyfriend wanted to drive her crazy and hurt her. A gentleman trying to hail
a taxi accidentally bumped into her this morning, and she started screaming that her ex-
boyfriend had hired the man to throw her into the street under a car. Collette is on a 2-week
suspension from her job as a restaurant server because she was combative to a customer—
she accused him of colluding with her ex-boyfriend to get her fired. After this morning’s
incident, her mother was so worried she brought her to the emergency room. Her
appearance is disheveled, she is clearly hyperalert and is crying that her boyfriend must
have converted her mother to work against her. Head imaging, screening lab, and a
toxicology screen are negative. A leading differential for Collette is:
Bipolar disorder
Acute psychotic episode
Schizophreniform disorder
Post-traumatic stress disorder
1 points
QUESTION 2
1. Jake and Laurie are a young married couple who have been referred to mental health
counseling because Jake is having disturbing sleep events. Laurie reports that on more than
one occasion she has awakened to find Jake having what appears to be a panic attack, but
he doesn’t seem to realize it. When he finally wakes up, he is confused and doesn’t really
understand what happened, although he does have a sense of intense fear. This has
happened twice in the last 2 weeks, and the last time Laurie heard him screaming. Jake is
now a bit afraid to go to sleep and as a result does not feel well the next day. The PMHNP
recognizes that sleep terrors in adults:
Are often associated with trauma or
psychiatric problems
Represent a disorder of REM sleep
, May be a symptom of temporal lobe epilepsy
Is treated with a cycle of sleep deprivation
1 points
QUESTION 3
1. Jack is a 27-year-old male who has a history of paranoid schizophrenia that first
became apparent approximately 10 years ago. He developed paranoid delusions and
eventually decompensated to the point that he required inpatient stabilization. At the time,
he was started on conventional antipsychotics, but due to intolerable adverse effects he was
switched to haloperidol. It worked well, but whenever he stopped taking it, symptoms would
recur. After several hospitalizations, he was stabilized. The neurophysiologic theory of
schizophrenia suggests that Jack’s symptoms were a result of:
Increased dopamine activity in the
mesolimbic pathway
Increased dopamine activity in the
mesocortical pathway
Increased glutamate in the prefrontal cortex
Increased glutamate in the hippocampus
1 points
QUESTION 4
1. 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
