1|Page
NR 547 MIDTERM AND FINAL EXAM WITH
ACTUAL EXAM TIPS
Breathing-related sleep disorders -ANS-: obstructive sleep apnea (OSA)
-most common
-caused by upper airway obstruction during sleep
• leads to periods of apnea and heavy snoring
-commonly diagnosed in adults aged 40-60
-Risk factors: obesity and family hx
Breathing-related sleep disorders
-typically present with excessive daytime sleepiness
-trouble concentrating during the day, mood changes, awakening with a dry
mouth or sore throat, morning headaches, or decreased libido
-Partners may endorse snoring, apneic periods, and abrupt awakenings
accompanied by gasping or choking.
Circadian Rhythm Sleep-Wake Disorders -ANS- occurs when this endogenous, 24-
hour cycle is disrupted, causing excessive daytime sleepiness, insomnia, or both
-Disruptions in sleep schedule due to illness or shift work may cause transient
disorder, while non-24-hour sleep-wake disorder may cause chronic disturbances
in sleep
-common disorder of clients with blindness due to their inability to see light.
Minh is a 19-year-old who presents to the emergency department after a suicide
attempt. She is medically stable. She states that she has experienced auditory
hallucinations for the past 3-4 weeks and "could not take them anymore." She
also complains of depressed mood, loss of interest in activities, and feelings of
hopelessness for the past few months. Her toxicology reports on admission were
negative.
,2|Page
Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR),
what is the most appropriate diagnosis for Minh? include ICD-10 code: - ANSWER
schizoaffective disorder depressive type F25.1
Rationale: Minh presents with major depressive episode concurrent with
hallucinations. This disturbance is not attributable to a substance. The most
appropriate diagnosis for Minh is schizoaffective disorder depressive type F25.1
Schizophreniform Disorder -ANS- characterized by schizophrenia-like symptoms
that last for more than 1 month but less than 6 months
-differentiated from schizophrenia based on the length of time symptoms have
been present
Holden is a 14-year-old who presents to the clinic with his parents. His mother
notes that he has stopped showering, seems disinterested in activities in which he
had previously engaged and in peer interaction, and echoes words that others
have said. These behaviors have increased over the past two months. Holden's
urine toxicology is negative.
Based on the DSM-5-TR, does Holden meet diagnostic criteria for
schizophreniform disorder?
yes
no
Unable to determine -ANS- No
Rationale: Holden's behaviors have lasted for at least one month, but less than
six months. His behaviors are not attributable to a substance. Holden displays
two of the five required symptoms for the diagnosis of schizophreniform
disorder. He displays catatonic behavior with echolalia and has negative
symptoms of asociality and avolition. He does not, however, display one of the
three required behaviors
,3|Page
for diagnosis: delusions, hallucinations, or disorganized speech. An alternate
diagnosis should be considered.
Brief Psychotic Disorder -ANS- an acute psychosis, often precipitated by stress
-Symptoms last for less than 1 month
-clients experience full remission with a full return to function
Shelby is a 31-year-old who presents to the emergency department with her
husband. She is 32 weeks pregnant. Her husband noted that a few days ago, she
began having bizarre behaviors, including avoiding eye contact, exhibiting
tangential speech, and expressing delusions that she is being followed and
tracked by the CIA and that they are planning to steal her baby. Shelby has no
medical or psychiatric history, and she is not on any medications. She has
abstained from alcohol during pregnancy and does not use other drugs.
Based on DMS-5-TR, does Shelby meet the criteria for brief psychotic disorder?
yes
no
Unable to determine -ANS- Unable to determine
Rationale: Shelby may meet diagnostic criteria for brief psychotic disorder (298.8)
with peripartum onset, but a diagnosis cannot be confirmed at this time. Shelby
exhibits delusions and disorganized speech. The symptoms cannot be better
explained by another medical or psychiatric illness or substance. Shelby's
symptoms began a few days ago. If symptoms resolve within one month, this is an
appropriate diagnosis. If not, an alternate diagnosis should be considered.
, 4|Page
Delusional Disorder -ANS- involves a person having prominent delusions without
hallucinations
-tend to have false beliefs that involve real-life situations
• ex: belief that they are being followed or that others are plotting against them
-often retain their personalities and are more functional socially
Geoff is two days post-op from knee surgery. He has been awake, alert, oriented,
and pleasant over the last few days and has shown no signs of mental distress.
The surgical team asked for a psychiatric consult after Geoff became increasingly
angry, argumentative, and agitated with nursing staff when he was offered a flu
shot. Geoff states that he was given a flu shot against his will at work several
years ago, and since then the government has been tracking him and listening in
on private conversations. He states that taking another shot will "triple the
power" of the surveillance. Upon follow-up, Geoff's wife confirms that he has
held this belief for many years. He believes the same is true for other vaccines,
but he does not hold other delusions. He has maintained employment,
relationships, and social interactions.
Based on the DSM-5-TR, does Geoff meet diagnostic criteria for delusional
disorder?
yes
no
unable to -ANS- Yes
Rationale: Geoff has one belief that is irrational and fixed and has held the
delusion for several years. His functioning is not impaired. He meets diagnostic
criteria for delusional disorder
NR 547 MIDTERM AND FINAL EXAM WITH
ACTUAL EXAM TIPS
Breathing-related sleep disorders -ANS-: obstructive sleep apnea (OSA)
-most common
-caused by upper airway obstruction during sleep
• leads to periods of apnea and heavy snoring
-commonly diagnosed in adults aged 40-60
-Risk factors: obesity and family hx
Breathing-related sleep disorders
-typically present with excessive daytime sleepiness
-trouble concentrating during the day, mood changes, awakening with a dry
mouth or sore throat, morning headaches, or decreased libido
-Partners may endorse snoring, apneic periods, and abrupt awakenings
accompanied by gasping or choking.
Circadian Rhythm Sleep-Wake Disorders -ANS- occurs when this endogenous, 24-
hour cycle is disrupted, causing excessive daytime sleepiness, insomnia, or both
-Disruptions in sleep schedule due to illness or shift work may cause transient
disorder, while non-24-hour sleep-wake disorder may cause chronic disturbances
in sleep
-common disorder of clients with blindness due to their inability to see light.
Minh is a 19-year-old who presents to the emergency department after a suicide
attempt. She is medically stable. She states that she has experienced auditory
hallucinations for the past 3-4 weeks and "could not take them anymore." She
also complains of depressed mood, loss of interest in activities, and feelings of
hopelessness for the past few months. Her toxicology reports on admission were
negative.
,2|Page
Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR),
what is the most appropriate diagnosis for Minh? include ICD-10 code: - ANSWER
schizoaffective disorder depressive type F25.1
Rationale: Minh presents with major depressive episode concurrent with
hallucinations. This disturbance is not attributable to a substance. The most
appropriate diagnosis for Minh is schizoaffective disorder depressive type F25.1
Schizophreniform Disorder -ANS- characterized by schizophrenia-like symptoms
that last for more than 1 month but less than 6 months
-differentiated from schizophrenia based on the length of time symptoms have
been present
Holden is a 14-year-old who presents to the clinic with his parents. His mother
notes that he has stopped showering, seems disinterested in activities in which he
had previously engaged and in peer interaction, and echoes words that others
have said. These behaviors have increased over the past two months. Holden's
urine toxicology is negative.
Based on the DSM-5-TR, does Holden meet diagnostic criteria for
schizophreniform disorder?
yes
no
Unable to determine -ANS- No
Rationale: Holden's behaviors have lasted for at least one month, but less than
six months. His behaviors are not attributable to a substance. Holden displays
two of the five required symptoms for the diagnosis of schizophreniform
disorder. He displays catatonic behavior with echolalia and has negative
symptoms of asociality and avolition. He does not, however, display one of the
three required behaviors
,3|Page
for diagnosis: delusions, hallucinations, or disorganized speech. An alternate
diagnosis should be considered.
Brief Psychotic Disorder -ANS- an acute psychosis, often precipitated by stress
-Symptoms last for less than 1 month
-clients experience full remission with a full return to function
Shelby is a 31-year-old who presents to the emergency department with her
husband. She is 32 weeks pregnant. Her husband noted that a few days ago, she
began having bizarre behaviors, including avoiding eye contact, exhibiting
tangential speech, and expressing delusions that she is being followed and
tracked by the CIA and that they are planning to steal her baby. Shelby has no
medical or psychiatric history, and she is not on any medications. She has
abstained from alcohol during pregnancy and does not use other drugs.
Based on DMS-5-TR, does Shelby meet the criteria for brief psychotic disorder?
yes
no
Unable to determine -ANS- Unable to determine
Rationale: Shelby may meet diagnostic criteria for brief psychotic disorder (298.8)
with peripartum onset, but a diagnosis cannot be confirmed at this time. Shelby
exhibits delusions and disorganized speech. The symptoms cannot be better
explained by another medical or psychiatric illness or substance. Shelby's
symptoms began a few days ago. If symptoms resolve within one month, this is an
appropriate diagnosis. If not, an alternate diagnosis should be considered.
, 4|Page
Delusional Disorder -ANS- involves a person having prominent delusions without
hallucinations
-tend to have false beliefs that involve real-life situations
• ex: belief that they are being followed or that others are plotting against them
-often retain their personalities and are more functional socially
Geoff is two days post-op from knee surgery. He has been awake, alert, oriented,
and pleasant over the last few days and has shown no signs of mental distress.
The surgical team asked for a psychiatric consult after Geoff became increasingly
angry, argumentative, and agitated with nursing staff when he was offered a flu
shot. Geoff states that he was given a flu shot against his will at work several
years ago, and since then the government has been tracking him and listening in
on private conversations. He states that taking another shot will "triple the
power" of the surveillance. Upon follow-up, Geoff's wife confirms that he has
held this belief for many years. He believes the same is true for other vaccines,
but he does not hold other delusions. He has maintained employment,
relationships, and social interactions.
Based on the DSM-5-TR, does Geoff meet diagnostic criteria for delusional
disorder?
yes
no
unable to -ANS- Yes
Rationale: Geoff has one belief that is irrational and fixed and has held the
delusion for several years. His functioning is not impaired. He meets diagnostic
criteria for delusional disorder
