PMHNP Practicum 1: Barkley

On the Patient Health Questionnaire, a score of 15-19 indicates moderately severe depression. A score of 1-4 indicates minimal or no depression, whereas a score of 5-9 indicates mild depression. Moderate depression is indicated by a score of 10-14. A score of 20 or higher would indicate severe depression.

A 30-year-old woman who believes that she may be suffering from depression scores a 15 on the Patient Health Questionnaire. What do you tell her about her mental health? 1. She likely has moderate to severe depression. 2. She likely has severe or extreme depression. 3. She likely has mild or moderate depression. 4. She falls within the normal range and is not at risk for depression.

On the Patient Health Questionnaire, a score of 15-19 indicates moderately severe depression. 1-4 indicates minimal or no depression 5-9 indicates mild depression Moderate depression is indicated by a score of 10-14 20 or higher would indicate severe depression

A 30-year-old woman who believes that she may be suffering from depression scores a 15 on the Patient Health Questionnaire. What do you tell her about her mental health? She likely has moderate to severe depression. She likely has mild or moderate depression. She falls within the normal range and is not at risk for depression. She likely has severe or extreme depression.

4. Major depressive disorder Although avoidant/restrictive food intake disorder may precede anorexia nervosa in some patients, avoidant/restrictive food intake disorder does not present with fear of weight gain or body image disturbance and should not be diagnosed concurrently with anorexia nervosa. Anorexia nervosa commonly presents with psychiatric comorbidities such as generalized anxiety disorder, obsessive-compulsive disorder, and major depressive disorder.

A patient with anorexia nervosa may exhibit comorbidity for all of these disorders except: 1. Avoidant/restrictive food intake disorder 2. Generalized anxiety disorder 3. Obsessive-compulsive disorder 4. Major depressive disorder

Routine total skin examinations fall into the category of secondary prevention, which focuses on the early identification and treatment of existing problems. Primary prevention refers to measures that promote health prior to the onset of any recognizable problems; such measures include a healthy diet, exercise, avoiding tobacco, and immunizations. Tertiary prevention refers to the rehabilitation and restoration of health through means such as a cardiac rehabilitation after myocardial infarction or physical therapy after a motor vehicle crash. Quaternary prevention is not a recognized medical term.

A routine total skin examination would fall under which level of prevention? 1. Tertiary prevention 2. Secondary prevention 3. Primary prevention 4. Quaternary prevention

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).

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

In Aaron Beck's cognitive behavioral therapy, the downward arrow technique is used to explore the underlying assumptions in the patient's logic through exploration of the idea of consequence (e.g., "If this is true, then what happens/what does that say?"). Decatastrophizing focuses on reducing anxieties regarding the "worst case scenario" by getting the patient to plan for it, such as by asking the patient if he has a strategy for if he loses his job. Reattribution focuses on shifting the blame off of one's self in situations where one was not responsible for the outcome (e.g., a patient being let go due to economic constraints rather than fired due to poor performance). Paradox focuses on inflating a patient's anxieties to the extreme in order to showcase the underlying absurdities (e.g., "If any slip-up at work could get you fired, then why do any work at all?"); this should be done carefully, however, as the patient may view this as belittling or sarcasm.

All of the following are parts of Eric Berne's system of strokes except: 1. Life scripts 2. Neutral strokes 3. Games 4. Unconditional strokes

Hypnotherapy is not recommended for individuals suffering from severe psychiatric conditions such as antisocial personality disorder. Psychotherapy, as well as cognitive therapy, can be helpful in assisting individuals in making connections between their emotions and behaviors to attempt to change the way they think and behave. It is important, though, that the individual be amenable to therapy. Self-help groups can be very helpful, especially if the group is tailored to those with antisocial personality disorder. Individuals may be more likely to contribute to the group if they are surrounded by peers. Although it is not typically a first-line form of treatment, pharmacological therapy may be used for patients with acute concurrent disorders. These patients should be monitored very carefully to avoid misuse of medication.

All of the following are recommended treatments for antisocial personality disorder except: 1. Hypnotherapy 2. Psychotherapy 3. Pharmacological therapy 4. Self-help groups

1. The transtheoretical model is a conventional method of therapy for behavior modification; it is not a rehabilitation model for serious mental illness. The assertive community treatment model, multisystemic therapy, and the clubhouse model (i.e., the psychosocial rehabilitation model) are all treatment modalities for serious mental illnesses. Other examples of treatment modalities include the Fairweather lodge model and the psychiatric rehabilitation program.

All of the following are rehabilitation modalities for serious mental illnesses except: 1. Transtheoretical model 2. Assertive community treatment model 3. Multisystemic therapy 4. Clubhouse model

Headache is not a symptom associated with opioid withdrawal. Nausea, myalgia, and lacrimation are common adverse effects of opioid withdrawal

All of the following signs and symptoms in a patient would suggest opioid withdrawal except: 1. Lacrimation 2. Nausea 3. Headache 4. Myalgia

A thyroid function test may be used to rule out hypothyroidism in patients presenting with signs and symptoms of anorexia nervosa; however, it would serve little use in the diagnosis of bulimia nervosa. The diagnosis for both conditions may include blood urea nitrogen levels, serum glucose levels, and urinalysis, as well as serum calcium levels.

All of the following tests might see use in the diagnosis of both anorexia nervosa and bulimia nervosa except: Thyroid function test Serum glucose Blood urea nitrogen Urinalysis

A thyroid function test may be used to rule out hypothyroidism in patients presenting with signs and symptoms of anorexia nervosa; however, it would serve little use in the diagnosis of bulimia nervosa. The diagnosis for both conditions may include blood urea nitrogen levels, serum glucose levels, and urinalysis, as well as serum calcium levels.

All of the following tests might see use in the diagnosis of both anorexia nervosa and bulimia nervosa except: 1. Thyroid function test 2. Blood urea nitrogen 3. Urinalysis 4. Serum glucose

Repetitive meals do not predispose a patient to becoming delirious but can actually help prevent delirium, especially if the patient's favorite foods are incorporated. Up to 40% of all intensive care unit and coronary care unit patients demonstrate signs of delirium, as do up to 80% of all elderly inpatients. Exposure to continuous noise increases the risk of delirium due to sleep interruption.

All of these are predisposing factors for delirium except: 1. Being subjected to repetitive meals 2. Being subjected to continuous noise 3. Being an intensive care unit patient 4. Being an elderly inpatient

Repetitive meals do not predispose a patient to becoming delirious but can actually help prevent delirium, especially if the patient's favorite foods are incorporated. Up to 40% of all intensive care unit and coronary care unit patients demonstrate signs of delirium, as do up to 80% of all elderly inpatients. Exposure to continuous noise increases the risk of delirium due to sleep interruption.

All of these are predisposing factors for delirium except: Being an intensive care unit patient Being subjected to continuous noise Being subjected to repetitive meals Being an elderly inpatient

The Vanderbilt Assessment Scale is used to assess for attention-deficit/hyperactivity disorder, not dementia. The Cognitive Abilities Screening Instrument, St. Louis University Mental Status Exam, and Montreal Cognitive Assessment are all means of assessing for dementia.

All of these exams would be useful in assessing for dementia except: 1. Vanderbilt Assessment Scale 2. Montreal Cognitive Assessment 3. Cognitive Abilities Screening Instrument 4. St. Louis University Mental Status Exam

Sentinel events are not synonymous with "medical errors"-not all sentinel events occur because of an error, and not all errors result in a sentinel event. Sentinel events indicate an unexpected injury or death; when this occurs, clinicians and institutions are expected to conduct a root cause analysis to find out the reason for the injury or death.

All of these statements are true of sentinel events except: The word "sentinel" indicates the need for immediate investigation and response. A root cause analysis should be conducted in response to a sentinel event. The definition of sentinel events includes serious psychological injury. Sentinel events are synonymous with "medical errors."

Sexual abuse is often typified by inappropriate sexual knowledge or behavior for the patient's age, as well as poor peer relationships, delinquency, suicidal or self-destructive thoughts or actions, and a reluctance to change for gym or partake in physical education. Indiscriminate attention seeking is more symptomatic of physical abuse; behavior in victims of sexual abuse more often includes withdrawal, delinquency, self-destruction, fantasy, or infantile tendencies. Extended stays at school and habit disorders, such as rocking back and forth, are typical hallmarks of emotional abuse or neglect.

Amy, a 12-year-old female, has poor peer relationships, is a delinquent, and has suicidal fantasies. She adamantly refuses to participate in gym class and often fights with her teachers when asked to change for the class. Given the most likely diagnosis, what other behaviors should you most look for in Amy? 1. Rocking back and forth 2. Indiscriminate seeking of attention 3. Extended stays at school 4. Inappropriate sexual knowledge for her age

Agnosia is the inability to recognize and identify objects (wall clock) or faces (a niece). Aphasia is initially characterized by difficulty in expressing or understanding spoken words, h, but can progress to include memory and cognitive impairment. Anosognosia is a lack of awareness or a denial of a neurologic defect; this finding is usually seen in the later stages of Alzheimer's disease. Apraxia is the inability to carry out motor activities despite intact motor function.

An elderly woman with early Alzheimer's disease comes to your office for a follow-up appointment regarding her condition. When you speak to her, she frequently confuses her words. For example, she refers to her daughter as her niece and the clock on the wall as a watch. Which of the following signs is she demonstrating? 1. Apraxia 2. Aphasia 3. Anosognosia 4. Agnosia

People with narcissistic personality disorder (NPD) exhibit characteristics of grandiosity and arrogance, an overall lack of interest or empathy in others, and extreme sensitivity to criticism. Such individuals often experience success in their occupation but frequently have trouble sustaining loving, personal relationships. Individuals with obsessive-compulsive personality disorder tend to have a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency. Although individuals with histrionic personality disorder often self-dramatize and fish for compliments, their interactions are more often guided by sensitivities to the reactions of peers, rather than the disdain of others characteristic of NPD. Lastly, borderline personality disorder is characterized by an unstable self-image, impulsivity, and self-destructive behavior, rather than a self-centered attitude towards relationships with others.

Brittany, a 35-year-old female, has never been in a relationship where she didn't cheat on her boyfriend. Although she is exceptional at her job at a small accounting firm, she always gets very emotional when her boss points out areas where she can improve. In order to calm her down, her boss has to compliment her excessively. In the break room, Brittany is always talking about how she is going to run the company some day and turn it into a Fortune 500 firm. When she learned that her coworker's husband lost his job, Brittany commented that he must be lazy. Which of these personality disorders best explains Brittany's behavior? 1. Obsessive-compulsive 2. Borderline 3. Histrionic 4. Narcissistic

People with narcissistic personality disorder (NPD) exhibit characteristics of grandiosity and arrogance, an overall lack of interest or empathy in others, and extreme sensitivity to criticism. Such individuals often experience success in their occupation but frequently have trouble sustaining loving, personal relationships. Individuals with obsessive-compulsive personality disorder tend to have a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency. Although individuals with histrionic personality disorder often self-dramatize and fish for compliments, their interactions are more often guided by sensitivities to the reactions of peers, rather than the disdain of others characteristic of NPD. Lastly, borderline personality disorder is characterized by an unstable self-image, impulsivity, and self-destructive behavior, rather than a self-centered attitude towards relationships with others.

Brittany, a 35-year-old female, has never been in a relationship where she didn't cheat on her boyfriend. Although she is exceptional at her job at a small accounting firm, she always gets very emotional when her boss points out areas where she can improve. In order to calm her down, her boss has to compliment her excessively. In the break room, Brittany is always talking about how she is going to run the company some day and turn it into a Fortune 500 firm. When she learned that her coworker's husband lost his job, Brittany commented that he must be lazy. Which of these personality disorders best explains Brittany's behavior? Histrionic Narcissistic Obsessive-compulsive Borderline

Auditory hallucinations, loss of memory, and lack of personal hygiene are all markers of the acute phase of schizophrenia. Other signs and symptoms of this stage include illogical thinking, inappropriate social behavior, catatonic excitement, and poor concentration. The premorbid phase is indicated by depression, sleep disturbance, and bedwetting. The prodromal phase is characterized by suspiciousness, inappropriate expression of feeling, and feelings of unreality. Lastly, the stable phase is symptomatically similar to the prodromal phase.

Cam, a 23-year-old female, is brought to the hospital by her boyfriend. He states that she has been hearing voices, cannot remember anything, and refuses to take a shower or change her clothes. He adds, "She used to be a very clean person and had a really good memory." Which phase of schizophrenia is Cam most likely experiencing? Premorbid phase Prodromal phase Stable phase Acute phase

Difficulty making decision is a form of the controlled style of expressing feelings in an individual with acute rape trauma syndrome. These individuals may mask or hide their feelings, or appear calm, composed, or subdued. Smiling is an example of an expressed style of expressing feelings in acute rape trauma syndrome. Frequent crying, sobbing, hysteria, and tenseness are also observed in patients displaying an expressed style.

Chelsea, a 24-year-old female, is a victim of rape. While examining the patient, you suspect that she may be experiencing acute rape trauma syndrome and has assumed a controlled style of coping. Which of the following signs was likely exhibited to lead you to this conclusion? The patient is smiling. The patient is restless. The patient is tense. The patient shows difficulty making decisions.

When initiating a schizophrenia patient on clozapine, the patient should be instructed to titrate daily dosage by 25-50 mg to a target dosage of 300-450 mg/day, rather than 600-900 mg/day, and a single dose should never exceed 450 mg. The maximum allowable daily dose is 900 mg/day, but this dosage should not be targeted until the patient has reached a targeted daily dose of 300-450 mg/day. The patient should also be instructed to return for weekly complete blood count to monitor white blood count in order to prevent agranulocytosis.

Clozapine use requires rigorous dosing and monitoring in patients. Which of the following is the proper instruction for a patient being initiated on clozapine therapy for schizophrenia? Initiate therapy with a 6-mg dose, followed by a 12.5-mg dose Instruct the patient to return weekly for a complete blood count to monitor red blood cell levels Titrate daily dosage by 25-50 mg/day, as tolerated, to target dosage of 600-900 mg/day Dosage should never exceed 450 mg at one time

Elevated dopamine in the basal ganglia and decreased serotonin (5-HT) activity are most closely associated with thought disorders. These two findings are not a definitive diagnosis for a thought disorder but aid in the diagnostic process by ruling out other disorders. In mood disorders such as bipolar disorder, multiple neurotransmitters are believed to be involved, including 5-HT, norepinephrine, acetylcholine, gamma-amino-butyric acid, and peptides, with increased dopamine activity leading to manic states. Serotonin is usually elevated in patients with an anxiety disorder. Decreased levels of serotonin, norepinephrine, and dopamine are all linked to symptoms of depression.

Decreased serotonin receptor activity and elevated dopamine in the basal ganglia are most closely associated with which disorders? 1. Anxiety disorders 2. Thought disorders 3. Mood disorders 4. Depressive disorders

The patient is most likely experiencing mild depression, which is characterized by depressive symptoms that coincide with grieving. Transient depression is characterized by mood changes based on everyday disappointments. Moderate depression is associated with symptoms of dysthymic disorder, whereas symptoms of severe depression coincide with major depressive disorder or a bipolar disorder.

Gerry, a 65-year-old male, comes into the office saying that he has been feeling "really low on energy and sad most of the time." When you ask him if any life-changing events have occurred recently, he tells you that his wife passed away within the past year. Which level of depression is Gerry most likely experiencing? 1. Mild 2. Severe 3. Transient Moderate

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.

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 impulsive. Harriet is well-off and can support her family's needs. Harriet's stealing is described as pleasurable.

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.

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.

In the Fairweather Model, patients live together and operate a shared business as a way of developing autonomy and improving their social interaction skills. The clubhouse model provides individual patients with opportunities to help them return to paid employment. The assertive community treatment model provides job training and employment opportunities to patients. Multisystemic therapy is aimed at treating youths with serious mental illness without incorporating employment as a treatment goal.

In which of these rehabilitation models is a patient expected to help run a business? 1. Fairweather Lodge model 2. Multisystemic therapy model 3. Clubhouse model 4. Assertive community treatment model

The patient's aggressive impulses, coupled with tingling and chest tightness preceding the attack, suggest intermittent explosive disorder (IED); naltrexone and other opioid antagonists are not used to treat this condition. Fluoxetine and other SSRIs are recommended as first-line treatment for IED. Trazodone and beta blockers such as propranolol have likewise been shown to reduce aggressive behavior in patients with IED.

Jack, an 18-year-old male, was arrested for assaulting his high school classmate. When asked what happened, Jack says, "he looked at me the wrong way," which sent him "over the edge" and made him want to "utterly wreck him and everything he holds dear." He says he "doesn't know what got into him" because he usually doesn't get that angry. When you inquire if he felt any physical symptoms before he attacked, he says, "I felt all tingly and my chest was tight." Based on your suspected diagnosis, which treatment would not be effective? 1. Naltrexone 2. Fluoxetine 3. Trazodone 4. Propranolol

The patient's signs and symptoms are indicative of anorexia nervosa, which is associated with bradycardia, not tachycardia. Tachycardia is more closely associated with bulimia nervosa. Hypotension, pigmentation of the chest and abdomen, bradycardia, and a distended abdomen are all features associated with anorexia nervosa.

Jane is hospitalized for hypotension and tachycardia. During the physical exam, you notice abnormal pigmentation on her chest and abdomen. Also, her abdomen is distended and she has lost most of her pubic hair. Which of these signs or symptoms would be least characteristic of the type of eating disorder that Jane is most likely experiencing? 1. Hypotension 2. Tachycardia 3. Pigmentation of chest and abdomen 4. Distended abdomen

The patient's signs and symptoms are indicative of anorexia nervosa, which is associated with bradycardia, not tachycardia. Tachycardia is more closely associated with bulimia nervosa. Hypotension, pigmentation of the chest and abdomen, and a distended abdomen are all features associated with anorexia nervosa.

Jane is hospitalized for hypotension and tachycardia. During the physical exam, you notice abnormal pigmentation on her chest and abdomen. Also, her abdomen is distended and she has lost most of her pubic hair. Which of these signs or symptoms would be least characteristic of the type of eating disorder that Jane is most likely experiencing? Tachycardia Distended abdomen Pigmentation of chest and abdomen Hypotension

Although nursing interventions for anxiety disorders in adolescents may incorporate SSRIs, tricyclic antidepressants are not generally used in treating adolescents due to a more adverse side effect profile. Treatment modalities for anxiety disorders in adolescents are focused on maintaining the anxiety at a moderate level or below, improving the patient's social interaction, and developing coping strategies for patients to manage and prevent maladaptive symptoms (e.g., relaxation techniques).

Jeff, a 14-year-old male, is undergoing therapy for social anxiety. He worries excessively about his performance at school and especially fears presentations: "I know everyone will laugh at me if I screw up." He does not have many friends; he says that he is afraid people will leave him if they see his "true self." As a nurse practitioner, you know that long-term treatment would typically focus on all of the following modalities except: Maintaining anxiety at a reasonable level Teaching the patient relaxation techniques to manage his fear of others Prescribing a tricyclic antidepressant that will manage the patient's symptoms Providing situations in which the patient can exercise and improve his social skills

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.

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.

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 was unable to commit to a "No Harm" contract. 2. Jeremy experiences withdrawal from alcohol and cocaine. 3. Jeremy is ambivalent about his intent to commit suicide. 4. Jeremy has expressed suicidal thoughts.

ndividuals who missed the initial enrollment period for Medicare Part D will need to pay a late enrollment penalty; however, Medicare offers aid for those who need help meeting premiums, and individuals receiving this aid do not need to worry about the penalty. If an individual receives creditable prescription drug coverage (e.g., coverage from a current or former union or employer, coverage from the Department of Veterans Affairs) during the initial enrollment period, the penalty does not apply. The late enrollment penalty must be paid, as it is part of the premium; however, individuals have the right to request a reconsideration of their penalty.

John, a 36-year-old male, was injured on the job and now qualifies for Medicare under disability. He requires medication for chronic pain, but he is afraid he missed the eligibility window for Medicare Part D and may have to pay a penalty that he can barely afford. What would you tell him? 1. "Drug coverage from your union plan can't cover the eligibility gap." 2. "Once the penalty's in place, it can only be removed once it is paid off." 3. "You can defer on paying the penalty until you feel comfortable." 4. "There is aid available from Medicare if you're afraid of meeting the premium."

According to Jean Piaget, the child would be in the second stage of development-the preoperational stage, which occurs between the ages of 2 and 7 and is marked by symbolic play and understanding, non-contested respect for authority, and an indistinguishable perception of reality and fantasy. The formal operational stage, which occurs between the ages of 11 and 15, includes abstract thinking and complex problem solving. The concrete operational stage occurs between ages 7 and 11 and is characterized by the understanding of interspatial relationships and sequence of events. The sensorimotor stage is associated with the age group of 0-2 years and is defined by reflexive movements, the understanding of action and result, and self-differentiation.

Joshua is a young male who engages in an imaginary game with other children his age in your clinic's play area. When his father enters the play area to pick him up, Joshua tries to involve him in the game, acting as if he is another full participant. When the father makes it clear he is not involved, Joshua stops playing immediately. Joshua is in which of Jean Piaget's four stages of development? 1. Preoperational 2. Concrete operational 3. Sensorimotor 4. Formal operational

Behavioral therapy Behavioral therapy is considered first-line treatment for a patient with trichotillomania-the failure to resist the impulse of pulling one's hair out. Some patients may have urges to pull out other people's hair as well; when confronted, the behavior is usually denied. SSRIs may be helpful in treating patients with trichotillomania, but no form of pharmacotherapy has proven consistently useful in treating the condition. Antipsychotics are not successful pharmacological options for trichotillomania; neither is lithium, which often sees use in treating other mental disorders, such as gambling addiction or depression.

Kasey, a 4-year-old female, has had to switch preschools multiple times due to her behavioral problems. Teachers have told her parents that she insists on pulling her classmates' hair. When they confront her about it, she denies it. Her parents also suspect that she pulls her own hair out when they are not looking. They don't see her do it, but they find clumps of Kasey's hair around the house, and they have noticed that she has "lost a lot of hair" since onset of this behavior. Which of the following would be the best course of treatment for Kasey? 1. Lithium 2. SSRIs 3. Behavioral therapy First-generation antipsychotics

Although many patients have a demographic preference for their primary care provider, merely asking if the patient believes that you "will help him" would not provide information regarding his general health beliefs. The statement would more likely provide an opinion based solely on the patient's perception of the nurse practitioner (NP). Asking about the patient's attitude regarding disability and illness, preventative health practices, and taboos and cultural attitudes with regards to modesty and special procedures would all yield beneficial information to help the NP understand the patient's beliefs about health and healthcare.

Leon presents to the clinic with findings suggestive of bipolar disorder. As Leon is a recent immigrant from Haiti, you begin by giving him a cultural assessment. Which of the following questions would be least helpful in gaining information about Leon's health beliefs and practices? "How do you generally try to stay healthy?" "Do you believe that I will help you feel better?" "What do you think a mental disorder says about a person?" "Do you have any issues with undressing for an assessment?"

Setting fire during teenage years is not one of the diagnostic criteria for pyromania. Pyromania may begin in childhood, but insufficient evidence exists regarding the typical age of onset. Fire-setting during childhood is often seen as exploration; during adolescence, it is more often linked to conduct disorder, adjustment disorder, or attention-deficit/hyperactivity disorder. The fact that the suspect smiles as the building is burning suggests that he derives some sort of pleasure or gratification from setting fires, which is a criterion for pyromania. Fire-setting on multiple occasions and fascination with fire and its situational contexts (e.g., an interest in firefighting) are also diagnostic criteria for pyromania.

Matthew has recently been arrested for starting a fire at his high school. The police suspect that he was the perpetrator because they found him standing alone and smiling in front of the burning building. While talking to his parents, you learn that he has purposely lit things on fire on more than one occasion. They also say that he experiments with fire-retardant material and has expressed interest in becoming a firefighter. Matthew's obsession has only recently started and there was no indication of it throughout his childhood. Which characteristic does not meet any of the diagnostic criteria for pyromania? 1. Lighting things on fire on more than one occasion 2. The onset of fire-setting during teenage years 3. Interest in becoming a firefighter 4. Smiling as the building is burning down

One of the most involved areas of the brain seen in attention-deficit/hyperactivity disorder (ADHD) is the orbital frontal cortex. The raphe nucleus is the most involved circuit in patients with anxiety disorders. Some studies show that the basal forebrain and basal ganglia play a part in ADHD, but the basal forebrain is most often involved in mood disorders. Elevated dopamine in the basal ganglia is linked to thought disorders and psychotic symptoms.

One of the most involved areas of the brain seen in attention-deficit/hyperactivity disorder is the ___? 1. Basal ganglia 2. Basal forebrain 3. Orbital frontal cortex 4. Raphe nucleus

For a female patient with symptoms such as cramping stomach pain and burning on urination or a male patent with testicular tenderness, a chlamydia culture would be the definitive diagnostic test when diagnosing chlamydia. Although enzyme immunoassay and nucleic acid amplification tests are also methods used to help diagnose chlamydia, these tests are not the most definitive. Fluorescent treponemal antibody absorption is used to test for syphilis, not chlamydia.

Sally, a 28-year-old teacher, comes to your clinic. She says: "In the last few days, I've developed this cramping pain in my stomach and this burning feeling whenever I urinate." She asked her sexual partner, whom she began dating recently, if he had any similar symptoms. He told her that he also feels a burning sensation during urination and that his testicles "feel sore." Which of these is the most definitive test for the most likely diagnosis? 1. Enzyme immunoassay methods 2. Fluorescent treponemal antibody absorption 3. Chlamydia culture 4. Nucleic acid amplification test using urine sample

Signs and symptoms of chlamydia in men may include a mucoid or watery urethral discharge, dysuria, and testicular pain or swelling. Lower abdominal pain is more common in women with chlamydia, as is upper right quadrant abdominal tenderness, which may be an indicator of Fitz-Hugh-Curtis syndrome. Although gonorrhea may present with dysuria, testicular pain, increased frequency of urination, and discharge, the discharge is usually purulent or mucopurulent.

Simon, a 22-year-old male, has been sexually active with multiple partners. At your clinic, he states: "My testicles are swollen and they hurt, a lot. There's also this thick, cloudy stuff leaking from my penis that looks like snot." Given the most likely diagnosis, what other symptom would most help to confirm Simon's condition? Upper right quadrant abdominal tenderness Lower abdominal pain Dysuria Increased frequency of urination

Although prolonged exposure therapy is recommended for patients with post-traumatic stress disorder (PTSD), therapy would not begin with immediately reintroducing the patient to the stressful stimulus. Rather, therapy would begin with education and breathing retraining. Monitoring suicidal thoughts, decreasing counterproductive behaviors, and using adaptive strategies are all effective tools for immediate intervention in PTSD patients.

Since he was in a major car crash, George constantly replays the crash in his head. His wife, Susana, tells you that he is less responsive when she talks to him and gets anxious anytime he is near a highway. Suspecting that George is suffering from post-traumatic stress disorder, which of the following would not be an immediate, effective strategy for you to implement at this time? 1. Assessing and monitoring any suicidal thoughts 2. Suggesting she take him for a drive on the highway 3. Decreasing behaviors that are maladaptive and increase anxiety 4. Using adaptive strategies and mechanisms

The Vanderbilt Assessment is a tool that aids in the diagnosis of attention deficit hyperactivity disorder, as indicated by the patient's symptoms of restlessness, inattention, and lack of focus. The Mini-Mental State Exam assesses cognitive impairment in patients who are suspected of having dementia. The Patient Health Questionnaire is a self-assessment test for depression. The Denver II Test assesses mental development in children aged 6 years and younger.

Susan, a 15-year-old high school freshman, says she was able to complete middle school because she was smart enough to pass the tests without studying. However, high school is proving to be far more difficult, as she finds herself unable to focus in class. She is frequently distracted and moves from one assignment to another while not completing any important tasks. When she was younger, her parents took her to a specialist to determine if she had any learning disabilities, but she scored well on the exams. The nurse practitioner (NP) notices that Susan fidgets and squirms, then gets up and paces while she talks. Which of the following tests should the NP use to confirm the suspected diagnosis? 1. Denver II Test 2. Patient Health Questionnaire 3. Vanderbilt Assessment 4. Mini-Mental State Exam

The Vanderbilt Assessment is a tool that aids in the diagnosis of attention deficit hyperactivity disorder, as indicated by the patient's symptoms of restlessness, inattention, and lack of focus. The Mini-Mental State Exam assesses cognitive impairment in patients who are suspected of having dementia. The Patient Health Questionnaire is a self-assessment test for depression, and the Denver II Test assesses mental development in children aged 6 years and younger.

Susan, a 15-year-old high school freshman, says she was able to complete middle school because she was smart enough to pass the tests without studying. However, high school is proving to be far more difficult, as she finds herself unable to focus in class. She is frequently distracted and moves from one assignment to another while not completing any important tasks. When she was younger, her parents took her to a specialist to determine if she had any learning disabilities, but she scored well on the exams. The nurse practitioner (NP) notices that Susan fidgets and squirms, then gets up and paces while she talks. Which of the following tests should the NP use to confirm the suspected diagnosis? Mini-Mental State Exam Vanderbilt Assessment Denver II Test Patient Health Questionnaire

An individual heading to college who received the meningococcal vaccine between the ages of 11 and 15 and has not already received a booster shot should receive a meningococcal booster dose. If an individual is already following the recommended immunization schedule of the Centers for Disease Control and Prevention (CDC), no other vaccinations are necessary before starting college. The CDC recommends that the hepatitis A and hepatitis B vaccinations be given during infancy and toddlerhood. The mumps vaccine is given during infancy in combination with measles and rubella, with a booster dose at age 4-6 years.

Tom, an 18-year-old male, is heading off to college. While checking his history, you notice that he has received all his vaccinations at the time recommended by the Centers for Disease Control and Prevention, but has not received a check-up or visited his NP since he was 14. Along with a tuberculosis test, which of the following vaccinations or booster doses are you likely to recommend at this time? 1. Hepatitis A vaccine 2. Meningococcal vaccine 3. Mumps vaccine 4. Hepatitis B vaccine

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.

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

Asking if a person has ever felt bad about his or her drinking addresses the "guilt" component of the CAGE questionnaire. The CAGE questionnaire consists of C (Cut down: Have you ever felt you should cut down on your drinking?), A (Annoyed: Have people annoyed you by criticizing your drinking?), G (Guilty: Have you ever felt bad or guilty about your drinking?), and E (Eye Opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?). Questions regarding drinking at work, getting sick, and being unable to stop drinking do not fall within the guidelines of the CAGE questionnaire.

When completing the CAGE questionnaire with a suspected alcohol abuser, which of the following questions would you most likely ask? 1. "Do you ever feel like you can't stop drinking after you start?" 2. "Do you drink at work?" 3. "Have you ever felt bad about your drinking?" 4. "Have you ever gotten sick from drinking?"

Albert Ellis' rational-emotive therapy aims to eliminate the patient's self-defeating outlook on life by replacing it with a more tolerant, rational, and grounded look at the world. Although rational-emotive therapy may drive the patient to explore and trust his or her self, it is not the central aim; this is more of a key feature in Carl Rogers' person-centered therapy. Negation of the anxieties that disrupt interpersonal relations is the goal of Harry Stack Sullivan's interpersonal theory, whereas the behavioral therapy pioneered by Pavlov, Skinner, Bandura, and Wolpe focuses on breaking maladaptive habits.

Which of the following attainments is of key importance in rational-emotive therapy? 1. A willingness to explore and trust one's self 2. A tolerant and grounded view of life 3. A negation of anxiety 4. A break from maladaptive habits

Albert Ellis' rational-emotive therapy aims to eliminate the patient's self-defeating outlook on life by replacing it with a more tolerant, rational, and grounded look at the world. Although rational-emotive therapy may drive the patient to explore and trust his or her self, it is not the central aim; this is more of a key feature in Carl Rogers' person-centered therapy. Negation of the anxieties that disrupt interpersonal relations is the goal of Harry Stack Sullivan's interpersonal theory, whereas the behavioral therapy pioneered by Pavlov, Skinner, Bandura, and Wolpe focuses on breaking maladaptive habits.

Which of the following attainments is of key importance in rational-emotive therapy? A break from maladaptive habits A tolerant and grounded view of life A willingness to explore and trust one's self A negation of anxiety

Requiring a child to assume adult responsibilities, such as watching younger siblings all day, is a sign that the child is being physically neglected by a parent. Emotional abuse may include verbal assault (e.g., referring to the child as an "idiot"), isolation (e.g., refusing to allow the child to attend sleepovers or have play dates), and rejection (e.g., pushing the child away when she tries to give a hug).

Which of the following behaviors is least demonstrative of emotional abuse of a child? 1. The mother requires the 10-year-old child to watch her two younger siblings every day during the summer. 2. When the child goes to hug the mother, the mother pushes her away. 3. The mother refers to the child as an "idiot." 4. The mother does not let the child attend sleepovers or have play dates.

Child victims of physical abuse tend to present with language deficits, such as monosyllabic speech, rather than aimless, chattering speech patterns. Indiscriminate seeking of affection, a constant effort to please parents, and going to extremes to call attention to one's self are all suggestive of physical abuse. Other behaviors suggestive of physical abuse include wariness of adult contact, fear of parents or going home, and extremes of behavior (e.g., aggressiveness, withdrawal).

Which of the following behaviors would least indicate physical abuse by a parent in a pediatric patient? Constant effort to please parents Indiscriminate seeking of affection Aimless, chattering speech patterns Extreme attention-getting behavior

Although patients with bulimia nervosa are obsessed with their weight and body image, they typically maintain a normal or above average weight; purging is performed as a compensatory measure for binge eating. People with bulimia tend to exhibit histrionic characteristics, are often sexually active, and tend to have an ego-dystonic view of their abnormal eating behaviors.

Which of the following is an incorrect statement about bulimia nervosa? 1. Bulimia is closely tied to histrionic behavior. 2. A person with bulimia is likely to feel ashamed of his or her condition. 3. A person with bulimia typically undergoes significant weight loss. 4. Individuals with bulimia are often sexually active.

Although patients with bulimia nervosa are obsessed with their weight and body image, they typically maintain a normal or above average weight; purging is performed as a compensatory measure for binge eating. People with bulimia tend to exhibit histrionic characteristics, are often sexually active, and tend to have an ego-dystonic view of their abnormal eating behaviors.

Which of the following is an incorrect statement about bulimia nervosa? 1. A person with bulimia is likely to feel ashamed of his or her condition. 2. A person with bulimia typically undergoes significant weight loss. 3. Bulimia is closely tied to histrionic behavior. 4. Individuals with bulimia are often sexually active.

Daniel Carlat's mnemonic for antisocial personality disorder, "CORRUPT," stands for the following: conformity to the law is lacking, obligations ignored, reckless disregard for safety of self or others, remorse lacking, underhanded, planning insufficient, and temper. "SUSPECT" is the mnemonic for paranoid personality disorder "DISTANT" is the mnemonic for schizoid personality disorder. "CRINGES" is the mnemonic for avoidant personality disorder.

Which of the following is the appropriate mnemonic for identifying antisocial personality disorder? CORRUPT DISTANT SUSPECT CRINGES

Most inpatients who develop a suicide plan and follow it have agreed to a "No Harm" contract. The most common method of suicide among inpatients is hanging, not self-inflicted wounds. When "unsolvable" problems at work, school, or home motivate the ideation, inpatients are most likely to attempt suicide either within the first 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.

Which of the following is true about suicide among inpatients? Most patients who develop a suicide plan and follow it have agreed to a "No Harm" contract. Self-inflicted wounds are the most common means of suicide. Inpatients with bipolar disorder are most likely to commit suicide. Patients who attempt suicide due to "unsolvable" problems usually do so after a month in care.

Most inpatients who develop a suicide plan and follow it have agreed to a "No Harm" contract. The most common method of suicide among inpatients is hanging, not self-inflicted wounds. When "unsolvable" problems at work, school, or home motivate the ideation, inpatients are most likely to attempt suicide either within the first 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

Which of the following is true about suicide among inpatients? Patients who attempt suicide due to "unsolvable" problems usually do so after a month in care. Inpatients with bipolar disorder are most likely to commit suicide. Self-inflicted wounds are the most common means of suicide. Most patients who develop a suicide plan and follow it have agreed to a "No Harm" contract.

According to studies, 19.2% of all men experience anxiety, compared to 30.5% of all women. Approximately 12%-25% (a quarter) of the U.S. population has experienced anxiety at least once in their lifetime, and anxiety is more common among lower socioeconomic groups. The majority of anxiety patients have initially sought help from a primary care source, rather than a mental health care provider or other resource.

Which of the following statements about anxiety disorder is false? Approximately 30.5% of men have experienced anxiety within their lifetime. Up to one quarter of the U.S. population has experienced anxiety at least once. It is more common among lower socioeconomic groups. Most patients who have anxiety initially seek help from their primary care physician.

Although economic status is a common consideration in determining family structure and roles, determining the patient's level of education is not necessary. Asking whether any other relatives live in the house provides information on the family's composition. How affection is demonstrated between relatives is another key concern, as are child-rearing practices (e.g., whether a mother breastfed her children). Other characteristics to explore include household rules, major events, special rituals, views on alcohol and drugs, and religion.

Which of the following would not be an appropriate question to ask in order to gain information about family roles? 1. "Did you breastfeed your children?" 2. "Do any other relatives live in your house?" 3. "What level of education did you complete?" 4. "How do you show affection for your children?"

Desmopressin is the preferred agent for pharmacological treatment of nocturnal enuresis in children. Imipramine is effective in reducing nighttime wetting but is not recommended due to risk of fatality from overdose. Oxybutynin is more effective in treating daytime wetting than nighttime wetting and is more likely to cause adverse side effects than desmopressin. Although tolterodine has proven effective in managing voiding disorders, it is not recommended for patients younger than age 12.

Which of these agents would be best suited for treating a 6-year-old female with nocturnal enuresis? 1. Imipramine 2. Tolterodine 3. Oxybutynin 4. Desmopressin

A rehabilitation model focusing on strength should, above all else, emphasize that the patient can achieve a positive quality of life despite mental illness. Helping the patient find meaningful work, getting others to understand the patient's illness, and helping the patient's family get involved in psychoeducation and/or supportive therapy are all reasonable goals or outcomes of therapeutic management; however, getting the patient to understand that he or she can live a positive life despite his or her condition is key, as it provides a foundation for progress and encourages a positive mindset that will aid the rehabilitative process

Which of these aspects is most critical for the long-term management of serious mental illness? 1. Helping the patient's family understand how to provide supportive therapy 2. Helping the patient find employment and/or meaningful work 3. Getting others to understand the nature of the patient's illness 4. Getting the patient to believe a positive quality of life is possible regardless of condition

Although simple motor tics (e.g., shoulder shrugging) and copropraxia are both associated with Tourette's disorder, a patient must present with multiple motor tics and at least one vocal tic to meet the criteria for the condition. Other diagnostic criteria for Tourette's disorder include persistence of symptoms for at least 1 year, onset of symptoms before 18 years of age, and a lack of underlying physiological cause (e.g., substance use, another medical condition).

Which of these criteria would not be considered diagnostic for Tourette's disorder? 1. The tics consist of repetitive shrugging and copropraxia. 2. The tics have been present for at least 18 months. 3. There is no underlying physiological cause for the tics. 4. The tics first presented at 6 years of age.

Unlike with bulimia nervosa, patients with binge eating disorder typically do not exhibit sustained dietary restriction between episodes. In both disorders, patients often engage in episodes of "bingeing"-eating large portions of food in a discrete period of time and feeling unable to control one's eating. Patients with either bulimia nervosa or binge eating disorder are likely to be within the normal weight to overweight range.

Which of these findings would most likely confirm a patient is dealing with binge eating disorder rather than bulimia? 1. The patient is slightly overweight. 2. The patient maintains a normal diet between episodes. 3. The patient feels a loss of control while eating. 4. The patient consumes an abnormally large meal in a small window of time.

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.

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

Females and certain minority groups are less likely to commit suicide than males and Caucasian individuals. Hence, although 10%-15% of all patients with schizophrenia commit suicide, a Latina female with schizophrenia would be at relatively low risk for suicide. A 62-year-old Caucasian female with bipolar disorder would be at higher risk, as older patients are more likely to complete suicide. Older Caucasian men have the highest suicide rate of any age and race, and patients with major depressive disorder account for 40%-60% of all suicides. A young African-American male who has a history of abusing alcohol would be at moderate risk, as 20% of all suicides had a history of alcohol use disorder.

Which of these patients would be at lowest risk for suicide? 1. A 62-year-old Caucasian female with bipolar disorder 2. A 32-year-old African-American male with alcohol use disorder 3. A 26-year-old Latina female with schizophrenia 4. A 73-year-old Caucasian male with major depressive disorder

Females and certain minority groups are less likely to commit suicide than males and Caucasian individuals. Hence, although 10%-15% of all patients with schizophrenia commit suicide, a Latina female with schizophrenia would be at relatively low risk for suicide. A 62-year-old Caucasian female with bipolar disorder would be at higher risk, as older patients are more likely to complete suicide. Older Caucasian men have the highest suicide rate of any age and race, and patients with major depressive disorder account for 40%-60% of all suicides. A young African-American male who has a history of abusing alcohol would be at moderate risk, as 20% of all suicides had a history of alcohol use disorder.

Which of these patients would be at lowest risk for suicide? A 32-year-old African-American male with alcohol use disorder A 62-year-old Caucasian female with bipolar disorder A 73-year-old Caucasian male with major depressive disorder A 26-year-old Latina female with schizophrenia

Multisystemic therapy is a rehabilitation model aimed at treating children and adolescents with serious mental illness; under this model, parents and teachers are taught skills to manage mental disorders so that the patient does not need to be removed from the community for hospitalization. Multisystemic therapy is not aimed at adults and does not directly focus on community reintegration or finding employment.

Which of these patients would most likely receive rehabilitation under the multisystemic therapy model? A 32-year-old female who has completed inpatient treatment for schizophrenia A 16-year-old male undergoing treatment for bipolar disorder A 63-year-old female diagnosed with frontotemporal neurocognitive disorder A 27-year-old male with major depressive disorder seeking employment

Discontinuing healthcare services because a patient is unable to pay for the services would qualify as patient abandonment, especially if done without proper notice at an unreasonable time (e.g., right before the patient begins an extensive course of treatment). With reasonable notice, refusal to accept a case based on lack of competency does not qualify as patient medical abandonment. Making arrangements to re-assign the patient to another practitioner and providing reasonable notice also does not indicate patient abandonment. Nurse practitioners are not abandoning patients if they refuse to work a double-shift on short notice.

Which of these scenarios would be an example of patient abandonment? A patient comes in at the end of your shift, and you are asked to stay later but have not been given proper notification. You discontinue the physician-patient relationship before an extensive course of treatment begins because your patient has not paid physician fees for 3 months. You have made arrangements for your patient to continue ongoing care with another nurse practitioner. You feel that a patient's case is too difficult for you to take.

Although a fine hand tremor is a potential side effect of therapeutic use of lithium, a coarse hand tremor is suggestive of lithium toxicity. Diarrhea and other gastrointestinal complications may occur with toxicity but are expected with normal doses of lithium. Other side effects associated with therapeutic use of lithium include polyuria, dermatologic disturbances, polydipsia, and weight gain.

Which of these side effects would be of greatest concern for a patient taking lithium? Skin rash Coarse hand tremor Polyuria Diarrhea

Depressive disorder with seasonal pattern, or seasonal affective disorder (SAD), is characterized by two major depressive episodes in the last 2 years linked to a particular season or time of year (e.g., autumn). In some patients with SAD, the change of seasons may result in a shift from a depressive episode to a manic or hypomanic episode; however, the seasonal onset of mania alone does not suggest SAD. A diagnosis of SAD requires that major depressive episodes are not linked to a psychosocial stressor (e.g., grief from the loss of a loved one) and do not present outside of the seasonal window.

Which of these statements from a patient would most strongly indicate seasonal affective disorder? "Whenever spring comes around, it feels like I can't keep up with my thoughts." "Ever since my husband died, I've always felt hopeless around Christmas." "For the last 3 years, I've just felt worthless every day during autumn." "I feel down throughout most of the year, but it gets especially bad in winter."

Selegiline, an MAO inhibitor, sees use in the treatment of Parkinson's disease, not alcohol withdrawal. Following the cessation of withdrawal signs and symptoms, patients may be given disulfiram to serve as a deterrent against future alcohol consumption. Benzodiazepines and carbamazepine are effective in alleviating the adverse effects of alcohol withdrawal.

Which pharmaceutical is not recommended for managing symptoms of alcohol withdrawal or preventing relapse? 1. Carbamazepine 2. Benzodiazepines 3. Disulfiram 4. Selegiline

Selegiline, an MAO inhibitor, sees use in the treatment of Parkinson's disease, not alcohol withdrawal. Following the cessation of withdrawal signs and symptoms, patients may be given disulfiram to serve as a deterrent against future alcohol consumption. Benzodiazepines and carbamazepine are effective in alleviating the adverse effects of alcohol withdrawal.

Which pharmaceutical is not recommended for managing symptoms of alcohol withdrawal or preventing relapse? Carbamazepine Disulfiram Benzodiazepines Selegiline

According to the National Institute on Alcohol Abuse and Alcoholism, men may be at risk for alcohol-related problems if they regularly drink more than four alcoholic drinks per day or 14 standard drinks per week. Women may be at risk for alcohol-related problems if they consume more than three drinks per day or more than seven standard drinks per week.

You are a nurse practitioner, and you've noticed that your 35-year-old friend, Andrew, has been drinking more than usual, causing him to miss work sporadically. Of the following questions you can ask Andrew, which one is most closely aligned with the National Institute on Alcohol Abuse and Alcoholism guidelines for determining alcohol-related problems? 1. "How often do you have more than four drinks containing alcohol in a day?" 2. "How often do you have more than three drinks containing alcohol in a day?" 3. "Does your alcohol consumption exceed 10 standard drinks per week?" 4. "Does your alcohol consumption exceed seven standard drinks per week?"

During an assessment interview for suicide risk, the nurse practitioner (NP) should not hide risk estimation from the patient; the information should be shared with the patient to establish a sense of mutual understanding and trust. For the assessment interview, patients should be asked to fill out a written self-report on suicidal ideation and behavior. The NP should inquire into protective factors (e.g., support from family and friends) and risk factors (e.g., impulse control problems) to estimate the degree of risk.

You are conducting an assessment interview for a patient who says, "I've been thinking a lot about killing myself lately." While completing the assessment, you make the four choices below. Which of those choices was least helpful to the assessment? 1. You do not disclose risk estimation to the patient so as to avoid facilitating ideation. 2. You establish if the patient has a history of impulse control problems. 3. You inquire into the patient's relationship with family and friends. 4. You have the patient fill out a self-report on suicidal ideation and behavior.

In counseling, immediacy is demonstrated by clearly and swiftly laying out the relationship between patient and counselor; as such, a counselor stating that he or she feels the patient's honesty represents forward movement reflects this skill. Concreteness is centered on having a patient express his or her feelings in clear and concrete terms, such as explaining how feelings of "emptiness" manifest or affect everyday life. By letting the patient know that the counselor understands his or her feelings and is not there to pass judgment, the counselor demonstrates empathy. Confrontation requires the counselor to point out discrepancies between the patient's stated emotions, body language, and actions, such as asking a grieving mother why she went to a party soon after her loss.

You are counseling a patient who has recently lost her child in a car accident. Which of these statements during the session would best reflect the skill of immediacy? 1. "When you say you feel 'empty,' I need to know how that affects your life." 2. "I feel that your honesty about your emotional state indicates we're moving forward." 3. "If you're still grieving, why did you go to that party?" 4. "Mourning takes many forms. Here, you can grieve as you feel best; no one will judge."

Chlordiazepoxide is specifically indicated for treating anxiety stemming from alcohol withdrawal syndrome. Buspirone, paroxetine, and clomipramine may all treat generalized anxiety disorder, but none of these drugs are specifically indicated to treat anxiety stemming from alcohol withdrawal syndrome.

You are educating Laura, your 25-year-old female patient, who is diagnosed with moderate generalized anxiety disorder resulting from alcohol withdrawal syndrome. You are teaching her relaxation techniques and ways to cope with occupational stress. She feels better afterwards, and she believes that she is better equipped to handle her triggers. Two weeks later, Laura returns to the clinic, saying that her anxiety "has gotten worse." She admits that she binged on alcohol, and that the recurring symptoms began immediately after she stopped drinking. Which drug would you most likely prescribe to the patient? Chlordiazepoxide Buspirone Clomipramine Paroxetine

Although enhanced cognitions for dealing with crisis aim to help the patient understand the hazard, enhanced cognitions do not particularly focus on the underlying psychology of why a certain event triggers a hazard response. The primary focus is on managing the hazard response by understanding the events that led up to it ("What were you doing before things got out of control?"), answering what is likely to happen next, identifying pros and cons of the situation ("Can you think of any positive outcomes for this situation?"), and generating a possible course of action ("What would you do next?").

You are helping a male patient develop enhanced cognitions for dealing with future crises by presenting him with a scenario involving an event that triggers a hazard response. Which of these questions would least likely aid in developing these enhanced cognitions? 1. "What were you doing before things got out of control?" 2. "What would you do next?" 3. "Why does this event in particular feel stressful?" 4. "Can you think of any positive outcomes for this situation?"

Patients with bipolar disorder who are misdiagnosed with another condition, such as schizophrenia, may receive insufficient treatment at a critical juncture, resulting in a greater risk of chronicity. Although substance use may trigger rapid cycling in patients with bipolar disorder, the patient has sworn off alcohol, thus reducing the risk of cycling into a depressive episode. The patient likewise takes antipsychotics to manage his manic episodes, indicating proper treatment for mood disorder. Patients with short manic episodes have an increased chance of better outcomes over the course of treatment.

You are meeting with a new patient who has bipolar II disorder. Which of these statements from the patient would most strongly indicate a risk of chronicity? 1. "You know, for 6 months, the doctors thought it was schizophrenia ..." 2. "I was a bit of a drinker, but I kicked the habit after I was diagnosed." 3. "My manic phases are short, but when they hit ... hoo, boy ..." 4. "I've been taking haloperidol. It's been keeping me level, even if the side effects aren't fun."

Patients with bipolar disorder who are misdiagnosed with another condition, such as schizophrenia, may receive insufficient treatment at a critical juncture, resulting in a greater risk of chronicity. Although substance use may trigger rapid cycling in patients with bipolar disorder, the patient has sworn off alcohol, thus reducing the risk of cycling into a depressive episode. The patient likewise takes antipsychotics to manage his manic episodes, indicating proper treatment for mood disorder. Patients with short manic episodes have an increased chance of better outcomes over the course of treatment.

You are meeting with a new patient who has bipolar II disorder. Which of these statements from the patient would most strongly indicate a risk of chronicity? "You know, for 6 months, the doctors thought it was schizophrenia ..." "I was a bit of a drinker, but I kicked the habit after I was diagnosed." "My manic phases are short, but when they hit ... hoo, boy ..." "I've been taking haloperidol. It's been keeping me level, even if the side effects aren't fun."

The patient's tradition of sleeping in late on her birthday is least helpful in a cultural assessment because it is not a cultural feature that may be related to any mental health concerns. Asking about the patient's view of America and whether or not her family has been discriminated against may affect levels of trust and safety between the patient and the PMHNP. Learning about the patient's ethnic origin, primary language, and special health practices provides the PMHNP with insight into the patient's cultural practices, which increases cultural competence and allows the NP to provide culturally sensitive healthcare.

You are performing a cultural assessment on Jane, a first-generation American. During the assessment, she reveals that she is Mexican and primarily speaks Spanish at home. She believes in treating "hot" illnesses with "cold" remedies and always sleeps in late on her birthday. She says that she has taken to America quite well but fears others have treated her coldly out of the belief that she is "an illegal." Which of the characteristics shared by Jane is least helpful in a cultural assessment? 1. Her belief in "cold" treatments for "hot" illnesses 2. Her predisposition towards Spanish 3. Her tradition of sleeping in late on her birthday 4. Her experiences with discrimination

Benztropine, an anticholinergic, is the preferred medication for treating patients experiencing dystonia, in addition to other extrapyramidal side effects, resulting from use of typical antipsychotics (e.g., haloperidol). Dantrolene is the recommended treatment for neuroleptic malignant syndrome in patients who are taking atypical antipsychotics. Carbamazepine is an antiepileptic used to control seizures, but is believed to cause tardive dystonia as well. Entacapone is used to minimize the risk of dyskinesias in patients with Parkinson's disease, whereas benztropine is the preferred treatment for antipsychotic-induced dyskinesias.

You are seeing your 43-year-old female patient in urgent care. She says: "The backs of my legs are locking up. I can't walk. It feels like my leg muscles are contracting and won't stop." As you examine her, you note that she is having difficulty walking as her leg muscles contract uncontrollably. When taking her history, she tells you that she has been taking haloperidol for a month to manage her schizophrenia. Which of the following is the preferred medication for treating the patient? 1. Entacapone 2. Carbamazepine 3. Dantrolene 4. Benztropine

A positron emission tomography (PET) scan of the brain shows localized mental activities and displays regional cerebral blood flow. A PET scan is also helpful in evaluating metabolic activity and neurotransmitter activity. Although an MRI can map cerebral blood flow, this method is discouraged in patients with metallic implants such as pacemakers. Brain mapping (i.e., computed tomography) shows the brain's structure but does not show localized activities. An electroencephalography test measures electrical activity in the brain but does not map cerebral blood flow.

You are studying the localized mental activities of a schizophrenic patient with a pacemaker. You seek to map cerebral blood flow. Which test are you most likely utilizing on this patient? 1. Electroencephalography 2. Brain mapping 3. MRI 4. Positron emission tomography

In Aaron Beck's cognitive behavioral therapy, the downward arrow technique is used to explore the underlying assumptions in the patient's logic through exploration of the idea of consequence (e.g., "If this is true, then what happens/what does that say?"). Decatastrophizing focuses on reducing anxieties regarding the "worst case scenario" by getting the patient to plan for it, such as by asking the patient if he has a strategy for if he loses his job. Reattribution focuses on shifting the blame off of one's self in situations where one was not responsible for the outcome (e.g., a patient being let go due to economic constraints rather than fired due to poor performance). Paradox focuses on inflating a patient's anxieties to the extreme in order to showcase the underlying absurdities (e.g., "If any slip-up at work could get you fired, then why do any work at all?"); this should be done carefully, however, as the patient may view this as belittling or sarcasm.

You have decided to use Aaron Beck's method of cognitive behavior therapy in treating a patient. Which of these statements would best illustrate the downward arrow technique? "Do you have a strategy in place for if you lose your job?" "Do you think losing your job was your fault or a downturn in the economy?" "If any slip-up at work could get you fired, then why do any work at all?" "If missing work could get you fired, what does that say about your workplace?"

In Aaron Beck's cognitive behavioral therapy, the downward arrow technique is used to explore the underlying assumptions in the patient's logic through exploration of the idea of consequence (e.g., "If this is true, then what happens/what does that say?"). Decatastrophizing focuses on reducing anxieties regarding the "worst case scenario" by getting the patient to plan for it, such as by asking the patient if he has a strategy for if he loses his job. Reattribution focuses on shifting the blame off of one's self in situations where one was not responsible for the outcome (e.g., a patient being let go due to economic constraints rather than fired due to poor performance). Paradox focuses on inflating a patient's anxieties to the extreme in order to showcase the underlying absurdities (e.g., "If any slip-up at work could get you fired, then why do any work at all?"); this should be done carefully, however, as the patient may view this as belittling or sarcasm.

You have decided to use Aaron Beck's method of cognitive behavior therapy in treating a patient. Which of these statements would best illustrate the downward arrow technique? 1. "Do you think losing your job was your fault or a downturn in the economy?" 2. "If missing work could get you fired, what does that say about your workplace?" 3. "If any slip-up at work could get you fired, then why do any work at all?" 4. "Do you have a strategy in place for if you lose your job?"

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 quetiapine and risperidone may be preferred due to reduced chance of side effects.

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

Alcohol withdrawal symptom can result in delirium tremens, a medical emergency characterized by body tremors, disorientation, agitation, and autonomic hyperactivity, among other signs and symptoms. Cannabis withdrawal, which may be managed with benzodiazepines, may cause tremors or agitation, but disorientation is not typical. Opioid withdrawal does not usually cause body tremors, disorientation, or agitation; dysphoric mood, nausea, muscle aches, and lacrimation are more common. Stimulant withdrawal, which does not require pharmaceutical intervention, is characterized by dysphoric mood, fatigue, and psychomotor retardation.

Your patient, Adam, has just been admitted to the hospital because of body tremors, disorientation, and agitation. His cardiac indices and oxygen consumption are significantly elevated. He was just started on IV therapy with benzodiazepines to control withdrawal symptoms. Three days ago, Adam began detoxification of which substance? 1. Cannabis 2. Opioids 3. Cocaine 4. Alcohol

Alcohol withdrawal symptom can result in delirium tremens, a medical emergency characterized by body tremors, disorientation, agitation, and autonomic hyperactivity, among other signs and symptoms. Cannabis withdrawal, which may be managed with benzodiazepines, may cause tremors or agitation, but disorientation is not typical. Opioid withdrawal does not usually cause body tremors, disorientation, or agitation; dysphoric mood, nausea, muscle aches, and lacrimation are more common. Stimulant withdrawal, which does not require pharmaceutical intervention, is characterized by dysphoric mood, fatigue, and psychomotor retardation.

Your patient, Adam, has just been admitted to the hospital because of body tremors, disorientation, and agitation. His cardiac indices and oxygen consumption are significantly elevated. He was just started on IV therapy with benzodiazepines to control withdrawal symptoms. Three days ago, Adam began detoxification of which substance? Opioids Alcohol Cocaine Cannabis

Primary prevention refers to measures that promote health prior to the onset of any recognizable problems, including vaccinations prior to traveling to a foreign country. Secondary prevention focuses on early identification and treatment of existing problems. Tertiary prevention refers to the rehabilitation and restoration of health. Although this patient likely receives secondary and tertiary prevention on a regular basis due to his amputation, secondary and tertiary prevention are not being practiced when vaccinations are being discussed and administered. There is no quaternary form of prevention.

Your patient, Dave, recently lost an arm in a heavy machinery accident at work. He is recovering well and is even playing soccer recreationally. He tells you that he will be traveling to Brazil to watch the Amputee Soccer World Cup. He also wants to travel around the country while he is there and asks you if he needs any vaccinations. What prevention level are you practicing with your patient? 1. Secondary prevention 2. Tertiary prevention 3. Quaternary prevention 4. Primary prevention