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BARKLEY PMHNP Pract.. ONE EXAMINATION [questuion and answers ]A+PRACTICE EXAM 2024-26

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BARKLEY PMHNP Pract.. ONE EXAMINATION [questuion and answers ]A+PRACTICE EXAM 2024-26

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BARKLEY PMHNP Pract.. ONE EXAMINATION
[questuion and answers ]A+PRACTICE EXAM
2024-26

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Although the patient may be Harriet is a well-established business woman who
rationalizing her behavior as a provides for her family. She was recently arrested
righteous act, patients with for stealing over $10,000 worth of merchandise
kleptomania do not commit theft to from the mall. When Harriet is asked to describe
express anger or vengeance. her behavior, she says: "It just comes on me quickly,
Kleptomania is characterized as and when it's done, I feel really good." She also
failing to resist the impulse to steal, describes how she grew up poor and sees the theft
and the stolen objects are typically as a way to "even the score" against those with
not needed. The act of stealing, "empty wealth." Which of the following does not
which usually is performed alone, meet the diagnostic criteria for kleptomania?
gives the person gratification. 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.

,Borderline personality disorder is not Tony, a 16-year-old male, has been sent to your
considered a differential diagnosis clinic for counseling. He has a long record of
for conduct disorder, as indicated by skipping school, talking back to his teachers, and
the patient's truancy, defiance of getting poor grades. His parents say he has often
authority figures, fights with family gotten in fights with them, has frequently been
members, poor academic caught sneaking girls into his room, and has run
performance, sexual promiscuity, away from home on two occasions. During the
running away from home, and "tough session, you notice Tony acts tough and aloof, not
guy" demeanor. Oppositional defiant deigning to speak much. If you suspect conduct
disorder, bipolar disorders, and disorder, which of the following conditions would
adjustment disorders are all you be least likely to include in your differential
considered potential differential diagnosis?
diagnoses for conduct disorder, as 1. Borderline personality disorder
are depressive disorders, attention- 2. Oppositional defiant disorder
deficit/hyperactivity disorder, and 3. Adjustment disorder with disturbance of conduct
intermittent explosive disorder. 4. Bipolar disorder


Depressive symptoms are associated Which of these lab findings would be least
with decreased, not increased, levels expected in a patient with depression?
of somatostatin in cerebrospinal 1. Decreased nocturnal growth hormone secretion
fluid. Patients with depression may 2. Decreased thyroid-stimulating hormone
exhibit a decreased thyroid- response
stimulating hormone response to 3. Increased somatostatin in cerebrospinal fluid
thyrotropin-releasing hormone, as 4. Increased secretion of cortisol
well as hypersecretion of cortisol.
Depressive symptoms are also
associated with irregularities in
growth hormone release, such as
reduced nocturnal secretion and
diurnal hypersecretion.

,Although ambivalence regarding Jeremy, a suicidal inpatient, is under close
suicidal intent should be taken into observation. He is able to be observed at all times
account when considering level of by hospital staff during waking hours and when he
observation in a patient, it indicates a sleeps, and is checked on every 15-30 minutes.
moderate risk, not a severe risk. Which of these reasons would least indicate the
Close observation should be need for this level of supervision?
employed with patients who profess 1. Jeremy has expressed suicidal thoughts.
suicidal thoughts, are unable to 2. Jeremy experiences withdrawal from alcohol and
commit to a "No Harm" contract, or cocaine.
experience withdrawal. 3. Jeremy is ambivalent about his intent to commit
suicide.
4. Jeremy was unable to commit to a "No Harm"
contract.


The patient's recent involvement in Adam, a 23-year-old male, is undergoing an STD
risky pleasurable activity (e.g., test at your clinic. When you ask him why he is here,
unprotected sex), increase in goal- he says, "I'm here because I've had this increased
driven activity at work, decreased craving for sex. I've been picking up strangers in
need for sleep, and subjective bars, not caring about using protection ... I don't
experience of racing thoughts all know what it is. For the last week, I've just felt really
suggest a manic episode; as such, driven. Keep throwing myself into my work, don't
bupropion, an antidepressant, would feel much need for sleep, feel like my thoughts are
not be considered because the running a marathon in my head." The patient lives a
patient has not displayed the "clean life," clarifying that he does not abuse any
diagnostic criteria for a major substance, "not even coffee or cigarettes." He also
depressive episode. Pharmacologic does not have a history of mental disorders. Given
options for the treatment of manic the most likely diagnosis, which of these
episodes include anticonvulsants medications would you least likely recommend for
(carbamazepine), antipsychotics Adam?
(haloperidol), and benzodiazepines Lorazepam
(lorazepam). Haloperidol
Carbamazepine
Bupropion

, Lorazepam would not be the first You have determined that a patient's delirium stems
choice to treat delirium in a from dehydration. As you begin treatment, you
dehydrated patient because realize the patient will require pharmacologic
benzodiazepines may cause management for his agitation. Which of these
respiratory depression, especially in agents would be least appropriate in this situation?
debilitated patients. Antipsychotics Risperidone
such as haloperidol, quetiapine, and Haloperidol
risperidone are considered the Quetiapine
mainstay in managing agitation in Lorazepam
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 effects.


Most inpatients who develop a Which of the following is true about suicide among
suicide plan and follow it have inpatients?
agreed to a "No Harm" contract. The Most patients who develop a suicide plan and
most common method of suicide follow it have agreed to a "No Harm" contract.
among inpatients is hanging, not Self-inflicted wounds are the most common means
self-inflicted wounds. When of suicide.
"unsolvable" problems at work, Inpatients with bipolar disorder are most likely to
school, or home motivate the commit suicide.
ideation, inpatients are most likely to Patients who attempt suicide due to "unsolvable"
attempt suicide either within the first problems usually do so after a month in care.
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.

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