Page 1 of 151
NURS 505 MIDTERM EXAM NEWEST 300
QUESTIONS AND VERIFIED SOLUTIONS
LATEST UPDATE THIS YEAR
NURS 505 MIDTERM EXAM
A 67 YO man is bib son & spouse for eval of his behavior. Last 6 months, has a false belief
spouse is having sexual relationships w/multiple people. Spouse states she has not been
sexually active for over 10 years. The son confirms he has been present when some of the
alleged behaviors have taken place & confirms no other relationships. The patient installed
security cameras around the house to "catch her in the act" & uncovered nothing. He recently
retired as a detective & is gathering evidence of spouse's infidelity. No alcohol or nonmedical
drug use. He takes a statin for cholesterol but is healthy. No prior mental health history and
reports no manic or depressive symptoms or hallucinations. His mood and affect are
euthymic. His speech is organized & behavior is polite. Which is the most likely diagnosis?
A. Bipolar disorder
B. Brief psychotic disorder
C. Delusional disorder
D. Paranoid personality disorder
ANS: C
Key Features of Delusional Disorder:
1
, Page 2 of 151
Non-bizarre delusion: The patient holds a fixed, false belief that his spouse is unfaithful. This
belief is plausible but not supported by evidence.
Duration: Symptoms have been present for 6 months, meeting the criterion of delusional
disorder for a duration of at least 1 month.
Preserved functioning: The patient’s behavior, aside from his delusion, is relatively normal. His
mood is euthymic, speech is organized, and he is polite in his interactions.
No other psychotic features: There is no evidence of hallucinations, disorganized speech, or
negative symptoms.
Subtype: This case specifically fits the jealous subtype of delusional disorder, which involves
delusions of infidelity.
Why Not Other Diagnoses:
Bipolar disorder:
While delusions can occur during manic or depressive episodes, this patient does not exhibit
symptoms of mania (elevated mood, increased energy) or depression.
Brief psychotic disorder:
This disorder involves psychotic symptoms (delusions, hallucinations, disorganized speech)
lasting less than 1 month. The duration of 6 months rules out this diagnosis.
Paranoid personality disorder:
2
, Page 3 of 151
Paranoid personality disorder involves pervasive distrust and suspicion of others, not fixed
delusions. In this case, the belief is a specific, isolated delusion rather than a pervasive
personality trait.
A 46 YO man presents for an evaluation. Diagnosed with alcohol use disorder one year ago, is
currently in a supervised treatment program, & has not had alcohol for the past six weeks.
Last use of alcohol was consistently drinking more than he intended with difficulty cutting
back despite its impact on his job from numerous unexcused absences. Lives at home
w/spouse & children, works at an office daily, spends time with colleagues & friends in the
evenings & on the weekends. Currently takes clonazepam prescribed to reduce the effects of
alcohol withdrawal. No hx of psychotic, depressive, or anxiety disorders. Medical history of
HTN & hyperlipidemia. 20-pack-year smoking history & current. He reports no use of drugs.
Which is the most appropriate diagnosis?
A. Alcohol use disorder in early remission
B. Alcohol use disorder in sustained remission
C. Alcohol use disorder, moderate
D. Alcohol use disorder, severe
ANS: A
Definition of Early Remission:
3
, Page 4 of 151
According to the DSM-5, alcohol use disorder in early remission is diagnosed when the
individual meets criteria for alcohol use disorder but has not met these criteria for at least 3
months but less than 12 months (except for craving).
Patient's History:
The patient was diagnosed with alcohol use disorder (likely moderate to severe given the
difficulty cutting back and impact on his job).
He has not consumed alcohol for the past six weeks, which qualifies as early remission.
Why Not Other Options:
Alcohol use disorder in sustained remission: This applies when the individual has not met the
criteria for alcohol use disorder for 12 months or longer (except for craving). This patient has
been abstinent for only six weeks.
Alcohol use disorder, moderate: This would describe an active alcohol use disorder. The
patient currently does not meet the criteria for alcohol use disorder because he is abstinent.
Alcohol use disorder, severe: Also implies ongoing alcohol use, which is not the case here.
A 35-year-old man is newly diagnosed with agoraphobia. He reports no marked agitation,
insomnia, or suicidal ideation. You discuss with him the different first-line treatment options.
The patient demonstrates a high level of motivation and prefers a problem-solving approach.
Which of the following treatments is most appropriate for this patient?
4
NURS 505 MIDTERM EXAM NEWEST 300
QUESTIONS AND VERIFIED SOLUTIONS
LATEST UPDATE THIS YEAR
NURS 505 MIDTERM EXAM
A 67 YO man is bib son & spouse for eval of his behavior. Last 6 months, has a false belief
spouse is having sexual relationships w/multiple people. Spouse states she has not been
sexually active for over 10 years. The son confirms he has been present when some of the
alleged behaviors have taken place & confirms no other relationships. The patient installed
security cameras around the house to "catch her in the act" & uncovered nothing. He recently
retired as a detective & is gathering evidence of spouse's infidelity. No alcohol or nonmedical
drug use. He takes a statin for cholesterol but is healthy. No prior mental health history and
reports no manic or depressive symptoms or hallucinations. His mood and affect are
euthymic. His speech is organized & behavior is polite. Which is the most likely diagnosis?
A. Bipolar disorder
B. Brief psychotic disorder
C. Delusional disorder
D. Paranoid personality disorder
ANS: C
Key Features of Delusional Disorder:
1
, Page 2 of 151
Non-bizarre delusion: The patient holds a fixed, false belief that his spouse is unfaithful. This
belief is plausible but not supported by evidence.
Duration: Symptoms have been present for 6 months, meeting the criterion of delusional
disorder for a duration of at least 1 month.
Preserved functioning: The patient’s behavior, aside from his delusion, is relatively normal. His
mood is euthymic, speech is organized, and he is polite in his interactions.
No other psychotic features: There is no evidence of hallucinations, disorganized speech, or
negative symptoms.
Subtype: This case specifically fits the jealous subtype of delusional disorder, which involves
delusions of infidelity.
Why Not Other Diagnoses:
Bipolar disorder:
While delusions can occur during manic or depressive episodes, this patient does not exhibit
symptoms of mania (elevated mood, increased energy) or depression.
Brief psychotic disorder:
This disorder involves psychotic symptoms (delusions, hallucinations, disorganized speech)
lasting less than 1 month. The duration of 6 months rules out this diagnosis.
Paranoid personality disorder:
2
, Page 3 of 151
Paranoid personality disorder involves pervasive distrust and suspicion of others, not fixed
delusions. In this case, the belief is a specific, isolated delusion rather than a pervasive
personality trait.
A 46 YO man presents for an evaluation. Diagnosed with alcohol use disorder one year ago, is
currently in a supervised treatment program, & has not had alcohol for the past six weeks.
Last use of alcohol was consistently drinking more than he intended with difficulty cutting
back despite its impact on his job from numerous unexcused absences. Lives at home
w/spouse & children, works at an office daily, spends time with colleagues & friends in the
evenings & on the weekends. Currently takes clonazepam prescribed to reduce the effects of
alcohol withdrawal. No hx of psychotic, depressive, or anxiety disorders. Medical history of
HTN & hyperlipidemia. 20-pack-year smoking history & current. He reports no use of drugs.
Which is the most appropriate diagnosis?
A. Alcohol use disorder in early remission
B. Alcohol use disorder in sustained remission
C. Alcohol use disorder, moderate
D. Alcohol use disorder, severe
ANS: A
Definition of Early Remission:
3
, Page 4 of 151
According to the DSM-5, alcohol use disorder in early remission is diagnosed when the
individual meets criteria for alcohol use disorder but has not met these criteria for at least 3
months but less than 12 months (except for craving).
Patient's History:
The patient was diagnosed with alcohol use disorder (likely moderate to severe given the
difficulty cutting back and impact on his job).
He has not consumed alcohol for the past six weeks, which qualifies as early remission.
Why Not Other Options:
Alcohol use disorder in sustained remission: This applies when the individual has not met the
criteria for alcohol use disorder for 12 months or longer (except for craving). This patient has
been abstinent for only six weeks.
Alcohol use disorder, moderate: This would describe an active alcohol use disorder. The
patient currently does not meet the criteria for alcohol use disorder because he is abstinent.
Alcohol use disorder, severe: Also implies ongoing alcohol use, which is not the case here.
A 35-year-old man is newly diagnosed with agoraphobia. He reports no marked agitation,
insomnia, or suicidal ideation. You discuss with him the different first-line treatment options.
The patient demonstrates a high level of motivation and prefers a problem-solving approach.
Which of the following treatments is most appropriate for this patient?
4
