FNP Review Dunphy-Chapter 18
Psychosocial Problems Questions with
Complete Solutions
You are seeing Marion, age 66, for a check of her hypertension. She says, "Since my husband
died, I started having a glass of wine before dinner. Now, it has become a glass of wine before
dinner, wine with dinner, and wine after dinner! Do you think I need to go to AA?" This
statement indicates that Marion is in what stage of change according to Prochaska's theory of
change?
A. Precontemplation
B. Contemplation
C. Preparation
D. Action C
Prochaska, a well-known psychologist who studies behavioral change, postulates a five-step
model of change. Precontemplation is when a person is unaware that a problem exists and/or is
not interested in change. Contemplation is when a person starts considering change. Preparation
is when someone begins to think of things to do about
the problem. Marion's thoughts about planning to go to AA demonstrates she has contemplated
the problem, noting the amount she is drinking, and is actually preparing to take action about the
issue, going to AA. Actual action is when the person actually initiates the action. Marion would
attend an AA meeting in this stage of change.
,You are seeing Joyce, age 36, who suffers from panic disorder. You have started her on
fluoxetine (Prozac) about a week ago. She comes to see you today complaining of diarrhea and
nausea. You advise
A. that she should stop taking this medication.
B. that she needs to try taking the medication with food and schedule her to see you in a week.
C. this is a common, long-lasting side effect of this medication but counsel that she should hang
in there as the therapeutic effect on panic disorder will be worth it.
D. that she should switch her to a different medication. B
Fluoxetine (also known by trade names Prozac and Sarafem) is an antidepressant of the selective
serotonin reuptake inhibitor (SSRI) class. It is used for the treatment of major depressive
disorder, obsessive-compulsive disorder (OCD), bulimia nervosa, panic disorder, and
premenstrual dysphoric disorder.
Jill, age 26, is diagnosed with schizophrenia. She exhibits a form of abnormal speech involving
creating new, idiosyncratic words. What is this form of speech referred to?
A. Derailment
B. Neologism
C. Word salad
D. Tangentiality B
,A neologism is the creation of new, idiosyncratic words. Derailment is switching topics without a
log- ical sequence. A word salad is words placed together without any sensible meaning.
Tangentiality is getting off the topic without answering questions appropriately.
You are seeing Sally, age 60, who is severely depressed. She is also complaining of inability to
sleep and anxiety. You must decide on what prescription to order for her. Which is most
dangerous if taken as an intentional overdose?
A. A 3-week supply of nefazodone (Serzone)
B. A 3-day supply of diazepam (Valium)
C. A 4-week supply of fluoxetine (Prozac)
D. A 2-week supply of nortriptyline (Aventyl, Pamelor) D
When choosing an antidepressant for a severely depressed client, the safety profile of the drug
must be considered. How toxic is the prescribed medication if the client takes an overdose? Of
the choices above, a 2-week supply of a tricyclic antidepressant, in this case nortriptyline, would
be the most lethal. The SSRIs, such as fluoxetine, and the atypical antidepressant nefazodone
have much better safety profiles when taken in over- dose. The dosage of diazepam is for an
extremely limited period.
James, aged 62, is on a selective serotonin reuptake inhibitor (SSRI) for his depression. While
the medication has helped his depression, he states that he has noticed a decline in sexual
function and asks about this. What do you tell him?
, A. "Keep taking it. You must acclimate your system to the medication. The sexual dysfunction
will get better. We will employ watchful waiting."
B. "You should stay on the medication and we can order a drug like sildenafil (Viagra) or
tadalafil (Cialis) to offset the adverse effects of the SSRI."
C. "While this medication has effectively helped with your depression, we'll go ahead and
change the classification of medication."
D. "Because this SSRI has helped your depression, that is the most important thing." C
Depressed patients who are troubled by SSRI sexual dysfunction may be switched to a non-SSRI
anti- depressant like bupropion (Wellbutrin). Watchful waiting alone is typically not effective.
While taking Viagra or Cialis may work, it is better to try another antidepressant than add an
additional med- ication. Telling James that he should be happy his depression is better is
negating the fact that he is concerned with sexual function and is not a thera- peutic response.
Which cranial nerve(s) are you assessing when you examine the client's mouth and tongue motor
movement for tardive dyskinesia?
A. Cranial nerves 9, 10, and 12
B. Cranial nerve 8
C. Cranial nerves 7 and 11
D. Cranial nerves 1, 2, and 3 A
Psychosocial Problems Questions with
Complete Solutions
You are seeing Marion, age 66, for a check of her hypertension. She says, "Since my husband
died, I started having a glass of wine before dinner. Now, it has become a glass of wine before
dinner, wine with dinner, and wine after dinner! Do you think I need to go to AA?" This
statement indicates that Marion is in what stage of change according to Prochaska's theory of
change?
A. Precontemplation
B. Contemplation
C. Preparation
D. Action C
Prochaska, a well-known psychologist who studies behavioral change, postulates a five-step
model of change. Precontemplation is when a person is unaware that a problem exists and/or is
not interested in change. Contemplation is when a person starts considering change. Preparation
is when someone begins to think of things to do about
the problem. Marion's thoughts about planning to go to AA demonstrates she has contemplated
the problem, noting the amount she is drinking, and is actually preparing to take action about the
issue, going to AA. Actual action is when the person actually initiates the action. Marion would
attend an AA meeting in this stage of change.
,You are seeing Joyce, age 36, who suffers from panic disorder. You have started her on
fluoxetine (Prozac) about a week ago. She comes to see you today complaining of diarrhea and
nausea. You advise
A. that she should stop taking this medication.
B. that she needs to try taking the medication with food and schedule her to see you in a week.
C. this is a common, long-lasting side effect of this medication but counsel that she should hang
in there as the therapeutic effect on panic disorder will be worth it.
D. that she should switch her to a different medication. B
Fluoxetine (also known by trade names Prozac and Sarafem) is an antidepressant of the selective
serotonin reuptake inhibitor (SSRI) class. It is used for the treatment of major depressive
disorder, obsessive-compulsive disorder (OCD), bulimia nervosa, panic disorder, and
premenstrual dysphoric disorder.
Jill, age 26, is diagnosed with schizophrenia. She exhibits a form of abnormal speech involving
creating new, idiosyncratic words. What is this form of speech referred to?
A. Derailment
B. Neologism
C. Word salad
D. Tangentiality B
,A neologism is the creation of new, idiosyncratic words. Derailment is switching topics without a
log- ical sequence. A word salad is words placed together without any sensible meaning.
Tangentiality is getting off the topic without answering questions appropriately.
You are seeing Sally, age 60, who is severely depressed. She is also complaining of inability to
sleep and anxiety. You must decide on what prescription to order for her. Which is most
dangerous if taken as an intentional overdose?
A. A 3-week supply of nefazodone (Serzone)
B. A 3-day supply of diazepam (Valium)
C. A 4-week supply of fluoxetine (Prozac)
D. A 2-week supply of nortriptyline (Aventyl, Pamelor) D
When choosing an antidepressant for a severely depressed client, the safety profile of the drug
must be considered. How toxic is the prescribed medication if the client takes an overdose? Of
the choices above, a 2-week supply of a tricyclic antidepressant, in this case nortriptyline, would
be the most lethal. The SSRIs, such as fluoxetine, and the atypical antidepressant nefazodone
have much better safety profiles when taken in over- dose. The dosage of diazepam is for an
extremely limited period.
James, aged 62, is on a selective serotonin reuptake inhibitor (SSRI) for his depression. While
the medication has helped his depression, he states that he has noticed a decline in sexual
function and asks about this. What do you tell him?
, A. "Keep taking it. You must acclimate your system to the medication. The sexual dysfunction
will get better. We will employ watchful waiting."
B. "You should stay on the medication and we can order a drug like sildenafil (Viagra) or
tadalafil (Cialis) to offset the adverse effects of the SSRI."
C. "While this medication has effectively helped with your depression, we'll go ahead and
change the classification of medication."
D. "Because this SSRI has helped your depression, that is the most important thing." C
Depressed patients who are troubled by SSRI sexual dysfunction may be switched to a non-SSRI
anti- depressant like bupropion (Wellbutrin). Watchful waiting alone is typically not effective.
While taking Viagra or Cialis may work, it is better to try another antidepressant than add an
additional med- ication. Telling James that he should be happy his depression is better is
negating the fact that he is concerned with sexual function and is not a thera- peutic response.
Which cranial nerve(s) are you assessing when you examine the client's mouth and tongue motor
movement for tardive dyskinesia?
A. Cranial nerves 9, 10, and 12
B. Cranial nerve 8
C. Cranial nerves 7 and 11
D. Cranial nerves 1, 2, and 3 A
