Nrnp 6670 week 6 midterm exam (100% correct
● question 1
0Out of 1 points
Sally is a 54-year-old female who presents for care at the urging of her employer.
She says that she doesn’t think she needs to be there, but the manager of her division at
work strongly suggested that she make an appointment. She is the evening shift manager
in the accounting department of a major online sales organization. Her role requires
meticulous accountability of a complex system of production statistics, and she has done
this exceedingly well for years. She has been a valued employee, and her work is above
reproach. A few months ago, the company adopted a new software program that required a
complete revamping of sally’s department. She has not adapted well, and her resulting
anxiety is almost prohibitive of functioning in her role. During her interview, sally is very
somber and serious, and is clearly having difficulty with this change. She is distraught over
the potential of not being able to do her job well and meet her immediate supervisor’s
expectations. Recognizing the likely diagnosis, the pmhnp knows that sally is likely to
respond best to:
Selected [none given]
Answer:
Answers: Pharmacotherapy
with clonazepam
Free-association, nondirective
Therapy
Interpersonal therapy
Serotonergic agents
Response (b) is the correct answer. These patients often recognize that there is a
Feedback problem and will do well with this form of therapy, although it is a long
: and complex process. Clonazepam and serotonergic agents are
Effective with obsessive-compulsive disorder, but their utility with
obsessive-compulsive personality disorder is less clear.
Interpersonal therapy is not among the therapeutic modalities with
any demonstrated success with this personality disorder.
● Question 2
0Out of 1 points
Becci is a 31-year-old female who presents to the pmhnp for evaluation after
being referred by her friend who is a patient of the practice. She describes a
relatively acute, recent onset of panic attacks. Becci says that “out of the blue” her heart
starts to race, her mouth gets dry, she gets shaky, and feels like she cannot get her breath.
She is afraid because her friend has panic disorder and becci knows that before her friend
got treatment, she basically would not leave the house in case an attack happened. The
pmhnp recognizes that the immediate priority in assessment for becci is:
selected
Answer:
a thorough physical examination
Answers:
, A thorough physical examination
a family history of mental health
disease
A urine drug screen an
assessment for phobic
disorder
Response (a) is the correct answer. While these are elements of a panic attack,
Feedback there are a variety of organic conditions that can cause these
: symptoms. Becci needs a physical examination and appropriate
laboratory assessment to rule out physiologic causes of her symptoms,
such as thyroid disease. The remaining elements above will all be part
of the mental health assessment once physical health is determined.
● Question 3
0 out of 1 points
Mrs. Bowen is a 33-year-old female who presents as a new patient requesting
medication for depression. She reports a long history of mood disorders on and
off going back to adolescence. She is very articulate in describing her history and
reports that neither sertraline nor fluoxetine “worked for her.” She was unable to remember
the dose or how long she took the medication. With respect to considering mrs. Bowen’s
medication history, the pmhnp knows that:
selected
Answer: Some forms of recurrent depression are best managed with
nonpharmacologic strategies
Answers: An snri will likely be the most appropriate choice if
pharmacotherapy is indicated for this episode
This may be an inaccurate characterization, as depressed patients
tend to overemphasize negatives
In some circumstances patients will purposefully mischaracterize the
Efficacy of medications they feel were ineffective
Some forms of recurrent depression are best managed with
nonpharmacologic strategies
Respons (b) is the correct answer. A common mistake among clinicians is to
e accept the depressed patient’s self-report of medication accuracy.
feedback
Depressed patients frequently overemphasize the negative and
:
minimize the positive and may genuinely have a misimpression of their
medications effectiveness; similarly, unrealistic expectations may skew
their impression of medication response. An snri may ultimately be the
most appropriate choice, but the pmhnp should not base this primarily
on the patient’s self-report of ssri response. This should not be
perceived as a purposeful mischaracterization – the patients are not
usually trying to misrepresent thing; they are reporting their genuine
impression. Finally, recurrent depressions spanning decades will most
likely require pharmacotherapy along with some form of
, nonpharmacologic intervention for best outcomes.
● Question 4
1 out of 1 points
Danielle is a 31-year-old female who is having a psychiatric evaluation at the
insistence of her husband. They have been married for 4 years, and her husband
has finally become so frustrated by her jealous behavior that he threatened to leave her if
she didn’t “get help.” Her husband insists that he has never been unfaithful, but danielle
repeatedly accuses him of having an affair. If he is even a few minutes late getting home
from work, she demands an explanation and then does not believe anything he says. She
does not have any real friends—her sister is her closest social contact, but danielle has
been angry with her for several weeks and won’t answer phone calls. Reportedly she does
this often, and according to her husband can “hold a grudge forever.” During the interview,
danielle is calm, responsive, but distant. She says she really doesn’t understand why she is
there—there is not a problem. The pmhnp considers the most likely diagnosis and discusses
with danielle that the treatment of choice is:
selected
Answer: Psychothe
r apy
Answers: Diazepam
pimozide
Psychother
apy group
therapy
Response (c) is the correct answer. Danielle’s symptoms and history are
Feedback consistent with paranoid personality disorder. Psychotherapy is the
: treatment of choice for this condition. These patients often do not do
well in group therapy as a rule, although for some it can increase social
skills. Pharmacotherapy is not a primary mechanism of treatment, but
when comorbid agitation and anxiety occur, diazepam may be used. In
some patients with quasidelusional thinking, pimozide has been
helpful.
● Question 5
1 out of 1 points
A 22-year-old male patient is started on sertraline 50 mg p.o. Daily after presenting
with a major depressive episode. After tolerating without difficulty for 2 weeks,
his dose is increased to 100 mg p.o. Daily. Approximately 4 weeks later he reports an
unusual set of new symptoms for the last week and a half. He says he feels “amped up” and
just very generally agitated and nervous. He was short- tempered at work and home and
was snapping at people for no good reason. He also reports difficulty concentrating at work.
Last week he expressed disproportionate anger at his work and his boss told him that he
was bipolar and should be put on medication. The pmhnp discusses with the patient that:
selected
, Answer:
when symptoms are preceded by antidepressant therapy, a diagnosis of
bipolar does not apply
Answers:
When symptoms are preceded by antidepressant therapy, a
Diagnosis of bipolar does not apply
His symptoms may be consistent with bipolar disorder if they persist
for at least 2 weeks
A formal assessment of the social and occupational implications of
his symptoms should be performed
The symptoms are most likely a physiologic adaptation to the
sertraline and most often normalize
Response (a) is the correct answer. Consistent with dsm-5 criteria, a manic
Feedback episode that emerges in response to an antidepressant does not
: constitute bipolar disorder. If these symptoms occur beyond the
natural washout period of the sertraline, then bipolar may be
appropriate. Symptoms have occurred long enough, as diagnostic
criteria require 1 week of symptoms most of the day. An assessment
of social and occupation impact will be helpful, but as his boss has
already commented, this appears possible. While there is a
physiologic adaptation to sertraline, that does not include symptoms
described here.
● Question 6
1 out of 1 points
Darius is a 26-year-old male who presents for care as part of couple therapy with
his wife, who is being seen for dependency issues. Darius himself seems very anxious to
“do the right thing” and appears to want to please the therapist. During the evaluation,
darius is impeccably dressed, very formal in his presentation and interaction, and is
watchful of time because he has an appointment after the interview and states several
times that he cannot be late. The pmhnp considers that darius may have obsessive
compulsive personality disorder (ocpd). In differentiating this from obsessive compulsive
disorder (ocd), she explores his history further for:
selected
Answer: Significant impairment at
work
Answers: A history of racing thoughts
difficulty interacting with
others
Extremely high expectations
of self
Significant impairment at
work
Response (d) is the correct answer. Ocd frequently leads to difficulty at work
Feedback because the symptoms interfere with the patient’s ability to
: successfully complete the workday; conversely, patients with ocpd
● question 1
0Out of 1 points
Sally is a 54-year-old female who presents for care at the urging of her employer.
She says that she doesn’t think she needs to be there, but the manager of her division at
work strongly suggested that she make an appointment. She is the evening shift manager
in the accounting department of a major online sales organization. Her role requires
meticulous accountability of a complex system of production statistics, and she has done
this exceedingly well for years. She has been a valued employee, and her work is above
reproach. A few months ago, the company adopted a new software program that required a
complete revamping of sally’s department. She has not adapted well, and her resulting
anxiety is almost prohibitive of functioning in her role. During her interview, sally is very
somber and serious, and is clearly having difficulty with this change. She is distraught over
the potential of not being able to do her job well and meet her immediate supervisor’s
expectations. Recognizing the likely diagnosis, the pmhnp knows that sally is likely to
respond best to:
Selected [none given]
Answer:
Answers: Pharmacotherapy
with clonazepam
Free-association, nondirective
Therapy
Interpersonal therapy
Serotonergic agents
Response (b) is the correct answer. These patients often recognize that there is a
Feedback problem and will do well with this form of therapy, although it is a long
: and complex process. Clonazepam and serotonergic agents are
Effective with obsessive-compulsive disorder, but their utility with
obsessive-compulsive personality disorder is less clear.
Interpersonal therapy is not among the therapeutic modalities with
any demonstrated success with this personality disorder.
● Question 2
0Out of 1 points
Becci is a 31-year-old female who presents to the pmhnp for evaluation after
being referred by her friend who is a patient of the practice. She describes a
relatively acute, recent onset of panic attacks. Becci says that “out of the blue” her heart
starts to race, her mouth gets dry, she gets shaky, and feels like she cannot get her breath.
She is afraid because her friend has panic disorder and becci knows that before her friend
got treatment, she basically would not leave the house in case an attack happened. The
pmhnp recognizes that the immediate priority in assessment for becci is:
selected
Answer:
a thorough physical examination
Answers:
, A thorough physical examination
a family history of mental health
disease
A urine drug screen an
assessment for phobic
disorder
Response (a) is the correct answer. While these are elements of a panic attack,
Feedback there are a variety of organic conditions that can cause these
: symptoms. Becci needs a physical examination and appropriate
laboratory assessment to rule out physiologic causes of her symptoms,
such as thyroid disease. The remaining elements above will all be part
of the mental health assessment once physical health is determined.
● Question 3
0 out of 1 points
Mrs. Bowen is a 33-year-old female who presents as a new patient requesting
medication for depression. She reports a long history of mood disorders on and
off going back to adolescence. She is very articulate in describing her history and
reports that neither sertraline nor fluoxetine “worked for her.” She was unable to remember
the dose or how long she took the medication. With respect to considering mrs. Bowen’s
medication history, the pmhnp knows that:
selected
Answer: Some forms of recurrent depression are best managed with
nonpharmacologic strategies
Answers: An snri will likely be the most appropriate choice if
pharmacotherapy is indicated for this episode
This may be an inaccurate characterization, as depressed patients
tend to overemphasize negatives
In some circumstances patients will purposefully mischaracterize the
Efficacy of medications they feel were ineffective
Some forms of recurrent depression are best managed with
nonpharmacologic strategies
Respons (b) is the correct answer. A common mistake among clinicians is to
e accept the depressed patient’s self-report of medication accuracy.
feedback
Depressed patients frequently overemphasize the negative and
:
minimize the positive and may genuinely have a misimpression of their
medications effectiveness; similarly, unrealistic expectations may skew
their impression of medication response. An snri may ultimately be the
most appropriate choice, but the pmhnp should not base this primarily
on the patient’s self-report of ssri response. This should not be
perceived as a purposeful mischaracterization – the patients are not
usually trying to misrepresent thing; they are reporting their genuine
impression. Finally, recurrent depressions spanning decades will most
likely require pharmacotherapy along with some form of
, nonpharmacologic intervention for best outcomes.
● Question 4
1 out of 1 points
Danielle is a 31-year-old female who is having a psychiatric evaluation at the
insistence of her husband. They have been married for 4 years, and her husband
has finally become so frustrated by her jealous behavior that he threatened to leave her if
she didn’t “get help.” Her husband insists that he has never been unfaithful, but danielle
repeatedly accuses him of having an affair. If he is even a few minutes late getting home
from work, she demands an explanation and then does not believe anything he says. She
does not have any real friends—her sister is her closest social contact, but danielle has
been angry with her for several weeks and won’t answer phone calls. Reportedly she does
this often, and according to her husband can “hold a grudge forever.” During the interview,
danielle is calm, responsive, but distant. She says she really doesn’t understand why she is
there—there is not a problem. The pmhnp considers the most likely diagnosis and discusses
with danielle that the treatment of choice is:
selected
Answer: Psychothe
r apy
Answers: Diazepam
pimozide
Psychother
apy group
therapy
Response (c) is the correct answer. Danielle’s symptoms and history are
Feedback consistent with paranoid personality disorder. Psychotherapy is the
: treatment of choice for this condition. These patients often do not do
well in group therapy as a rule, although for some it can increase social
skills. Pharmacotherapy is not a primary mechanism of treatment, but
when comorbid agitation and anxiety occur, diazepam may be used. In
some patients with quasidelusional thinking, pimozide has been
helpful.
● Question 5
1 out of 1 points
A 22-year-old male patient is started on sertraline 50 mg p.o. Daily after presenting
with a major depressive episode. After tolerating without difficulty for 2 weeks,
his dose is increased to 100 mg p.o. Daily. Approximately 4 weeks later he reports an
unusual set of new symptoms for the last week and a half. He says he feels “amped up” and
just very generally agitated and nervous. He was short- tempered at work and home and
was snapping at people for no good reason. He also reports difficulty concentrating at work.
Last week he expressed disproportionate anger at his work and his boss told him that he
was bipolar and should be put on medication. The pmhnp discusses with the patient that:
selected
, Answer:
when symptoms are preceded by antidepressant therapy, a diagnosis of
bipolar does not apply
Answers:
When symptoms are preceded by antidepressant therapy, a
Diagnosis of bipolar does not apply
His symptoms may be consistent with bipolar disorder if they persist
for at least 2 weeks
A formal assessment of the social and occupational implications of
his symptoms should be performed
The symptoms are most likely a physiologic adaptation to the
sertraline and most often normalize
Response (a) is the correct answer. Consistent with dsm-5 criteria, a manic
Feedback episode that emerges in response to an antidepressant does not
: constitute bipolar disorder. If these symptoms occur beyond the
natural washout period of the sertraline, then bipolar may be
appropriate. Symptoms have occurred long enough, as diagnostic
criteria require 1 week of symptoms most of the day. An assessment
of social and occupation impact will be helpful, but as his boss has
already commented, this appears possible. While there is a
physiologic adaptation to sertraline, that does not include symptoms
described here.
● Question 6
1 out of 1 points
Darius is a 26-year-old male who presents for care as part of couple therapy with
his wife, who is being seen for dependency issues. Darius himself seems very anxious to
“do the right thing” and appears to want to please the therapist. During the evaluation,
darius is impeccably dressed, very formal in his presentation and interaction, and is
watchful of time because he has an appointment after the interview and states several
times that he cannot be late. The pmhnp considers that darius may have obsessive
compulsive personality disorder (ocpd). In differentiating this from obsessive compulsive
disorder (ocd), she explores his history further for:
selected
Answer: Significant impairment at
work
Answers: A history of racing thoughts
difficulty interacting with
others
Extremely high expectations
of self
Significant impairment at
work
Response (d) is the correct answer. Ocd frequently leads to difficulty at work
Feedback because the symptoms interfere with the patient’s ability to
: successfully complete the workday; conversely, patients with ocpd
