BARKLEY DRT PMHNP Practicum 1 Study
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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.
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.
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
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.
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
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.
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.
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.
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
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).
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
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
Guide Complete Questions With Verified
Correct Answers | 100% Guaranteed Pass
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.
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.
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
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.
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
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.
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.
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.
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
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).
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
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
