NURS 6640 Midterm Exam

1. A PMHNP is caring for a 21-year-old woman who is suffering from anxiety and is having difficulty managing stress. Which of the following would be an appropriate step by the PMHNP? 1 points lOMoARcPSD| Downloaded by Boom Amor () D. Impact of Event Scale D 1 points True 1 points 1 points QUESTION 5 1. True or false: A PMHNP may ask his patient to describe her relationship with her father, both as a child and now, in order to assess interpersonal style. hours.” B. “Restrict the amount of time you spend in bed.” C. “Restrict the amount of exercise you do prior to going to bed.” D. “Restrict the amount of food you eat before bedtime.” B True A. Young Mania Rating Scale B. Hamilton Anxiety Rating Scale C. Dissociative Experiences Scale A. Group therapy B. Controlled confrontation C. A safe-place exercise D. Body and energy work 2 QUESTION 7 1. The PMHNP is caring for a patient who seems to seek affection and attention from the PMHNP and others in the clinic, as well as displays heightened emotional responses to feelings of being excluded. What therapeutic approach does the PMHNP use to decrease autonomic arousal in the patient? QUESTION 6 1. An initial evaluation reveals that an 11-year-old patient has moved to a new school after her parents‟ recent divorce, and is having trouble making friends. The patient has normal mental status and exhibits appropriate behavior. What is the most appropriate scale for the PMHNP to use to get False lOMoARcPSD| Downloaded by Boom Amor () NURS-6640 Midterm. C QUESTION 8 3 1 points NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () 35-year-ol pat ent seeks tre atment for D. QUESTION 10 1. A PMHNP‟s patients have already signed confidentiality agreements, including limits that will be imposed on confidentiality. Months later, the state‟s laws have changed that affect confidentiality promises the PMHNP has already made. What is an appropriate step for the PMHNP to take after finding out this information? 1 points QUESTION 11 1. The PMHNP is working with a school-aged child who has been diagnosed with depression. The child has attended several sessions with the PMNHP, but recently presents with avoidant behavior by showing increased distress and being late to sessions. What approach does the PMHNP need to employ with 1 points A. adaptive regression in the service of the ego B. regulation and control of affects and Q Ui m E SpTuIlsOeNs 9 1. AC. defensivedand iinterpersonal functioningdepression and anxiety after an abusive relationship. To help empower the patient, the PMHNP wants to tea s c e h ns th e e of saref e a - l p i t l y ac o e f t e h x e r w ci o s r e l d to an c d re o a f teth a e feeling of calm. In order to walk thesepla f tient through the exercise, the PMHNP first says: C A.“Identify an image of a safe place that makes you feel calm.” B. “Think about the things that cause you anxiety and let them go.” C. “Take a deep breath and start to relax with each new breath.” D. “Picture a beautiful beach and describe to me what you see.” A A. Revise intake forms to align with state laws B. Review confidentiality revisions with patients C. Have patients give informed consent again D. All of the above 1. A PMHNP is assessing ego functioning of his 40-year-old patient by asking what she feels is the cause of her problems. She attributes her problems to her overprotective parents not letting her have enough freedom growing up. Based on her answer, the PMHNP is testing . 1 points NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () must be completed, I will often complete it myself versus depending on someone else.” 1 points D. All of the above 1 points QUESTION 12 1. The PMHNP is treating a 35-year-old male officer in the military. He discloses that both of his parents are deceased and that he loved them. However, he says that he had feelings of inadequacy because his parents held him to a standard that he could never achieve. He went on to say that nothing he did ever felt good enough. The PMHNP assesses that this patient has perfect creases in his uniform with no strings or tags out of place; she also notices that he has perfect posture and questions him about ritualistic behaviors. She suspects that this patient has maladaptive responses to the expectations placed on him as a teenager and young adult. Which QUESTION 13 1. During a therapy session with an 18-year-old female the PMHNP learns that she has lived in six different foster homes in the last 24 months. She states that her mother is in a correctional facility for drug abuse and prostitution. During the assessment, the PMHNP notices multiple superficial cuts to each wrist. The patient appears tearful, withdrawn, and never makes direct eye contact. The PMHNP believes that this patient may have feelings of insecurities as well as abandonment issues and is aware that which the child to continue making therapeutic progress? A. Remaining quiet until the child is ready to talk B. Using communication techniques that are expressive C. Inviting the child‟s parents to speak on behalf of the child A. “I typically don‟t listen to anyone. I take care of my own wants and needs so I feel like no one can judge me or criticize me, period.” B. “I don‟t mean to hurt other people‟s feelings. When people cry or say that I have made them upset in some way, that‟s not my fault; some people are just sensitive.” C. “I like to listen to the beat of my own drum; I don‟t mind spending most of my days alone. I don‟t need recognition or praise; I would just like to be left alone.” D. “I believe in systems; I have to have order and rules in my everyday life. If a task A. Narcissistic personality disorder B. Obsessive-compulsive personality disorder C. Borderline personality disorder NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () D. Paranoid personality disorder QUESTION 14 1 points NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () QUESTION 15 1. The PMHNP is working with a patient who experiences anxiety around her parents that later leads to poor impulse control. What will the PMHNP do to employ psychodynamic psychotherapy properly for this patient? 1 points QUESTION 16 1. The PMHNP is working with a patient who seems dissatisfied with the therapeutic relationship. The PMHNP invites the patient to discuss her feelings regarding the PMHNP openly and honestly. It becomes clear to the PMHNP that they are experiencing an alliance rupture. How does the PMHNP repair the therapeutic alliance? 1 points QUESTION 17 1. The PMHNP is caring for a patient with borderline personality disorder. Using a psychoanalytic psychotherapy approach, the PMHNP attempts to intensify the patient‟s transference to enhance emotional processing by: 1 points A. Eat a heavy meal before bedtime to induce sleepiness B. Maintain a warm bedroom temperature C. Avoid watching television or reading in bed D. Try going to sleep at different times throughout the week to avoid monotony A. Emphasize the past B. Focus on expressions of emotion C. Identify patterns in relationships D. All of the above A. Responding to the patient in a nondefensive manner and accepting responsibility for the PMHNP‟s part in the tension B. Emphasizing with the patient‟s experiences and validating the patient for bringing it up C. Considering changing the goals of the patient‟s treatment D. All of the above A. Developing increased boundaries B. Decreasing supportive psychotherapy 7 1. In your office, you see a 58-year-old patient with PTSD who reports having nightmares, making it impossible for her to sleep. What recommendations based on principles of sleep hygiene will the PMHNP make? NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () C. Scaling back contact with the patient D. Increasing the number of sessions per week QUESTION 18 8 1 points NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () QUESTION 19 1. The patient is a 56-year-old female patient diagnosed with panic disorder and reports symptoms that include heart palpitations, frequent trembling, and feelings of choking in stressful situations. What special consideration does the PMHNP make? 1 points QUESTION 20 1. A 65-year-old patient has suffered the loss of his wife. He is in a state of hyperarousal with increased sympathetic nervous system arousal. One or more interventions may help the patient to deal with this arousal. To decrease sympathetic nervous system arousal, the PMHNP‟s treatment strategy is . 1 points QUESTION 21 1. The PMHNP is caring for a patient who the PMHNP believes would benefit from a relational psychodynamic approach to therapy. Which action made by the PMHNP demonstrates appropriate use and understanding of the relationship psychodynamic model? 1 points A. “The medication will help you forget the things that trigger your flashbacks.” B. “The medication takes a while to build up in your system and cure you.” C. “The medication may provide symptom relief, but you still need psychotherapy.” D. All of the above. A. Using a special focus on transference as the agent promoting change B. Confronting the emotional significance of the patient‟s symptoms C. Employing psychodynamic therapy combined with pharmacotherapy D. A and B A. mindfulness techniques B. deep breathing exercises C. self-regulation strategies D. all of the above A. Focusing the exploration on making the unconscious 1. The PMHNP is working with a patient who has dissociative disorder and requests pharmacological interventions for dealing with her trauma. What education does the PMHNP provide to the patient regarding NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () conscious B. Focusing the exploration on the genetic roots of the patient‟s problem C. Focusing the exploration on here and now D. None of the above QUESTION 22 1 points NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () QUESTION 23 1. The PMHNP has a session with a patient who was injured and traumatized from an explosion at the industrial plant where he used to work. During the session, an outside noise startles the patient and he experiences a flashback of the loud boom from the explosion. The PMHNP witnesses the patient present with anxiety and belabored breathing. What is the appropriate action of the PMHNP? 1 points QUESTION 24 1. The PMHNP is working with a veteran who has posttraumatic stress disorder (PTSD). The PMHNP believes that dual awareness will be beneficial in allowing the patient to focus on the here and now. What strategies can the PMHNP use to develop dual awareness in the patient? 1 points QUESTION 25 1. The PMHNP is working with a patient who experiences abreactions when discussing repressed feelings of his sexual abuse as a child. What can the PMHNP do to manage the patient‟s intense emotional reactions? 1 points A. employ cognitive behavioral therapy B. use empathy C. utilize intersubjectivity D. none of the above A. Telling the patient there is no reason to be startled B. Avoiding interrupting the flashback as it occurs C. Asking the patient to describe the flashbacks D. Have the patient use the relaxation response (take a deep breath, exhale long, and slow down) A. Asking the patient to recall a recent and mildly disturbing event B. Having the patient focus on details of the room, such as how hot or cold it is C. Telling the patient to rate the level of disturbance he feels from a mildly disturbing event D. All of the above A. Sit closer to the patient so the patient does not feel isolated B. Embrace the patient to provide physical comfort C. Suggest a relaxation technique, such as yoga or 1. The PMHNP is working with a 43-year-old male patient who develops idiosyncratic transference over weeks of therapy. The best way for the PMHNP to respond to this patient is to : NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () 1 points meditation D. All of the above NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () QUESTION 27 1. When a PMHNP is seeing a patient for the first time, what is an important step to assure that the patient and provider understand the limits of their discussion? 1 points QUESTION 28 1. An 11-year-old patient has been exhibiting low self-esteem at school and acting out. According to Maslow‟s hierarchy of needs, which of the following questions would best be addressed first by the PMHNP? 1 points QUESTION 29 1. A patient who has borderline personality disorder is meeting with the PMHNP. When asked about future goals, the patient responds, “I‟d like to go back to school to do what you 1 points A. will require more processing strategies B. would benefit from the stabilization stage C. is ready to move to Stage III, future visioning D. no longer needs to continue with therapy A. Assure the patient that she is safe to discuss her secrets B. Talk about the importance of being truthful and open C. Have a discussion about the confidentiality and its limits D. Mention the possible need for selective selfdisclosure A. “Are Joel‟s peers including him at recess?” B. “Does Joel feel safe and secure at school?” C. “Is Joel getting enough sleep at home?” D. “How can Joel feel that he is loved?” QUESTION 26 1. A 35-year-old patient has been seeking treatment for depression for several months. The PMHNP does an assessment to see if processing has led to adaptive change. The patient‟s self-references are positive in relation to past events, work is productive, relationships are adaptive, and there is congruence between behavior, thoughts, and affect. Based on this NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () A. “It is dangerous to fantasize about the future.” B. “I think that‟s an excellent idea! I can help you review the prerequisites!” C. “You may want to explore the requirements for becoming a PMNHP.” D. None of the above. do. You know, talk to people all day about their problems. It seems pretty easy.” How does the PHMNP respond to the client in a way that is free from any stigmatizing beliefs or judgments? NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () D. Say, “We can continue this session later if you prefer.” 1 points productivity 1 points 1 points QUESTION 32 QUESTION 31 1. Your patient is a 65-year-old male who has a strained relationship with his son and daughter. His children refuse to participate in a family session. The PMHNP asks the patient to draw his family genogram as a next step QUESTION 30 1. The PMHNP meets with a 47-year-old male patient who is fearful of leaving the house after having witnessed his neighbor getting run over by a car. When the PMHNP asks why he is afraid to leave his house, the patient replies, “Because another accident might occur.” Which cognitive behavioral therapy A. Pharmacological therapy B. Stress inoculation therapy C. Dialectical behavior therapy D. All of the above A. assess the patient‟s mental health status and functioning B. explore the interpersonal styles of each family member C. provide background information for the patient‟s family structure D. measure the patient‟s quality of well-being and 1. The PMHNP has been treating a 15-year-old patient with a history of abuse and neglect. Thirty minutes into their therapy session the patient jumps up and begins to pace around the room. Utilizing Socratic dialogue (SD) the PMHNP‟s best action would be to: A. Allow the patient time to process before speaking. B. Ask, “Why don‟t you come have a seat beside me?” while tapping the table. C. Say, “I noticed a change. Can you tell me what happened?” A. Interpreting unconscious conflict in the patient QUESTION 33 1. The PMHNP employs psychodynamic psychotherapy with a patient who experiences anxiety and depression. As the process enters the psychoanalytic end of the psychodynamic continuum, the PMNHP will focus 1 points NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () B. Restoring the patient‟s functioning and stabilization C. Reducing the patient‟s anxiety D. Strengthening the patient‟s defenses NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () False 1 points life?” D.All of the above. 1 points 1 points QUESTION 35 1. A PMHNP is taking a history and wants to assess how the patient copes with adversity. To do so, the therapist asks questions about the patient‟s belief system. What would be an appropriate question to ask? QUESTION 34 1. A 28-year-old male patient is experiencing distress related to the workplace. What might the PMHNP ask to assess affective development? A. “How do you think your colleagues feel about you?” B. “How do you calm yourself when you are upset at the office?” C. “How do you think your colleague felt when you blamed her?” D. All of the above. A. “What are your beliefs about therapy and seeking help?” B. “To what extent do your religious beliefs give you comfort?” C. “What gives you a sense of meaning and purpose in QUESTION 37 True 1. The PMHNP is caring for a patient with dissociated self-state that the PMHNP identifies as being associated with traumatic experiences in the patient‟s past. What approach does the PMHNP use with the patient that is crucial to the psychodynamic therapy process? A. Assisting the patient to experience and accept the various dimensions of the self through enhanced awareness of the traumatic states 1 points QUESTION 36 1. A new patient has been informed of the limits of confidentiality, and has signed informed consent forms. No consent, however, has been obtained for voluntary “Release of Information.” The patient is 20 years old and still lives at home with his parents. He is being treated for depression, which he attributes to the trouble he‟s had finding employment. True or false: If the patient‟s mother calls the PMHNP to check up on her son to see how he is doing, the therapist is required to protect patient NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () h a p ati ent during a session, allowed to share information. D. The PMHNP‟s response was ethical and legal because she was trying to answer the question. 1 points patient D.all of the above 1 points 1 points D. Providing empathy, understanding, and soothing to help the patient 1 points QUESTION 39 1. A PMHNP has been working with a young female patient who suffers from depression to change self-defeating behaviors. By creating a presence of acceptance and using good listening skills, the PMHNP‟s overall goal is to . QUESTION 40 1. When the patient comes into the office, she says, “I just saw a friend of mine out in the waiting room. What‟s wrong with him?” The PMHNP says, “He‟ll be fine. He has mild depression.” Which of the following statement is correct QUESTION 41 1. You are seeing a 29-year-old widow whose husband recently died overseas while serving his country in the military. She has been mourning the loss of her husband for several months, and continues to grieve. She refuses to go to group grieving sessions, but reports that she is still able to go to work and her fitness classes sometimes, and even makes attempts to stay social. She says, “Sometimes it‟s like he‟s not even gone. Other times it feels like B. Becoming a co-participant in the co-construction of the relationship with the patient, rather than an outside observer C. Making associations between an event or situation and the patient‟s feelings QUESTION 38 identify the other self-states After working wit A. Countertransference the student laments about all the things she should have, or could have, said to the patient. “I feel guilty th the student. The PMHNP understands that the student is exhibiting signs of which therapeutic concept? B. Therapeutic communication C. Empathy D. Boundaries A. deepen the patient‟s understanding of herself in order to cultivate empowerment B. slowly transfer authority to the patient when the PMHNP feels that she is ready C. remain caring, yet authoritative by making important decisions for the A. The PMHNP was not protecting patient confidentially rights. B. The PMHNP was not using identifying information in the patient situation above. C. Because the patient signed a consent form, the PMHNP was legally NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () A. “Now, I‟m sure your wife doesn‟t hate you.” B. “Where is the evidence that your wife hates you?” C. “You seem convinced that your wife hates you.” D. “What has your wife done to make you believe this?” A. Provide safety through case management strategies B. Help the patient manage positive and negative emotions C. Explore the meaning of significant adverse life experiences D. Process all dimensions of memory associated with the trauma QUESTION 43 1. The PMHNP is working with a patient who is living in poverty and abusing substances. According to the treatment hierarchy framework, what needs does the PMHNP need to attend to first? 1 points QUESTION 42 1. During cognitive behavioral therapy (CBT), a 64-year-old male patient, states, “My wife hates me! She‟s just waiting for me to die.” Using Socratic dialogue (SD) the PMHNP demonstrates understanding of analysis when she responds: 1 points 1 points A. Encouraging catharsis B. Encouraging abreaction to repressed feelings C. Identifying conflict-resolution techniques D. All of the above this type of stuff with my girlfriends, especially since all of their husbands are still alive.” The PMHNP understands that it is appropriate to employ NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () True False QUESTION 45 QUESTION 44 1. When conducting an initial assessment, a PMHNP has finished conducting a mental status examination with 10 minutes left in the session. The patient is distressed and would like to continue sharing her personal history. True or false: An appropriate response that the PMHNP might tell the patient is, “I understand that you are upset. [Summarizes diagnosis, treatment recommendations, and follow-up plan.] We can continue the conversation next week. How does this time next Monday work for you?” 1 points NURS-6640 Midterm. lOMoARcPSD| Downloaded by Boom Amor () QUESTION 46 1. The PMHNP is assessing a patient who grew up in a foster home because she was neglected and abused by her birth parents at a young age. The patient admits to having difficulty forming and maintaining relationships throughout her life. Understanding maladaptive schemas, which statement does the PMHNP predict that the patient is likely to make? 0 points QUESTION 47 1. The PMHNP has been assisting a shy and timid 23-year-old male patient struggling with esteem and self-concept issues. Over the weekend, this patient was given the task of completing an exercise that would usually cause him distress and shame, also called a shame-attacking exercise. The PMHNP determines that this task has successfully been achieved when the patient states: 1 points QUESTION 48 1. The PMHNP is treating a patient with a substantial fear of feeling closed in (claustrophobia). Thus, the patient will not get into an elevator. The office where he works is on the 10th floor and this requires that he walk up and down the stairs in the morning and evening to get to his office. With permission from the patient, the PMHNP is beginning systematic desensitization to address the patient‟s need to use the elevator. What is the PMHNP‟s best plan of action?