NURS 6640 midterm3 exam guide

QUESTION 1 The PMHNP understands that anxiety and depression are two disorders in which their symptoms may overlap. When discussing this, you explain that the autonomic nervous system is activated and further helps distinguish anxiety symptoms by making the following points: A. “You may experience an elevated heart rate, constant worrying, and diarrhea.” B. “You may experience fear, sweating, and muscle tension.” C . D. “You may experience sleepiness, decreased blood pressure, and fear.” 1 points QUESTION 2 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 the child to continue making therapeutic progress? “You may experience an elevated heart rate, the need to urinate, 1 and fear.” 1. All of the D . QUESTION 3 1 points above 1. 2. C . QUESTION 4 After informing a prospective patient about limits of confidentiality, the patient consents to the “conditions” of confidentiality and signs an informed consent form. Several weeks later, a lawyer representing the patient’s spouse for a court case, asks the PMHNP for the disclosure of information about the patient. The PMHNP should: Limit disclosure to the extent legally possible 1 points 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? C. Avoid watching television or reading in bed QUESTION 5 1 points 2 1. 2. C . QUESTION 6 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. 2. B . QUESTION 7 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 confidentiality and not disclose information. “Is Joel getting enough sleep at home?” A patient named Steve is seeking therapy to get help with his home situation, stating that he has been stressed since his mother-in-law moved into the house. What can the PMHNP do to assist the patient in constructing a narrative? 1 points Elicit details so Steve becomes more self-disclosing and self-examining True QUESTION 8 1 points 1 points 1. 2. 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: A. Developing increased boundaries B. Decreasing supportive psychotherapy C Scaling back contact with the patient . D. Increasing the number of sessions per week QUESTION 9 1 points 3 1. 1. 2. 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. True False QUESTION 10 1 points 1. 2. 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? 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) 1 points QUESTION 11 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? 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 QUESTION 12 1 points 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. 2. 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 productivity QUESTION 13 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 it’s been an eternity since I’ve seen him. It’s hard to talk about 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 which therapeutic principle? 2. A. Encouraging catharsis B. Encouraging abreaction to repressed feelings C. Identifying conflict-resolution techniques D. All of the above QUESTION 14 The PMHNP asks the patient to draw his family genogram as a next step to _______________. 4 1 points 1 points 1. 2. 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 ___________. A. mindfulness techniques B. deep breathing exercises C. self-regulation strategies D all of the above 1. 2. 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? . QUESTION 15 1 points A. Focusing the exploration on making the unconscious 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 16 1 points 5 1. 2. The PMHNP meets with an adolescent patient who has depression and often presents with resistance when discussing his parent’s divorce. For the past couple of sessions, the patient has been quiet, sometimes refusing to speak. To further support the therapeutic relationship, the PMNHP: 1. 2. 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? A. Observes and points out the behavior B. Stays quiet until the patient is ready to speak C. Brings in a colleague to help get the patient to talk D. None of the above QUESTION 17 1 points 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. AandB 1 points 1. 2. QUESTION 18 A 35-year-old patient seeks treatment for depression and anxiety after an abusive relationship. To help empower the patient, the PMHNP wants to teach the safe-place exercise to create a feeling of calm. In order to walk the patient through the exercise, the PMHNP first says: 1. 2. The PMHNP is meeting with a 38-year-old divorced, single mother who has been seeing the PMHNP for anxiety and anger management. During one of the sessions, the patient tells the PMHNP that she is having a problem getting her child support payments from her ex-husband, which is triggering increased anxiety and anger, which she admittedly takes out on her children. How does the PMHNP respond in a way that upholds the supportive psychodynamic psychotherapy approach? 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.” QUESTION 19 1 points A. Telling the patient to take a vacation to get away and relax B. Suggesting that she seek legal help C. Giving her advice about men and how to get them to pay child support D. Suggesting that the patient start going to church to help find more solace. QUESTION 20 1 points 6 1. 2. 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 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? 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. QUESTION 21 1 points 7 1. 2. 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 (CBT) strategy does the PMHNP employ? A. Pharmacological therapy B. Stress inoculation therapy C. Dialectical behavior therapy D. All of the above QUESTION 22 1 points 1. 2. 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 _____________. A. adaptive regression in the service of the ego B. regulation and control of affects and impulses C. defensive and interpersonal functioning D. sense of reality of the world and of the self QUESTION 23 1 points 1. 2. The PMHNP is working with a patient who has insomnia and battles going to sleep. The patient reports consistent self-defeating behaviors, and hates trying to go to sleep. Which action made by the PMHNP demonstrates the use of a paradoxical intervention? A. Telling the patient to start trying to go to sleep earlier, since it takes long to fall asleep B. Telling the patient to resist sleep and stay awake C. Having the patient perform a relaxing ritual before bedtime D Instructing the patient to avoid stimulants and sugars for 3 hours before 1. 2. 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? . falling asleep QUESTION 24 1 points A. Asking the patient what she does to relieve anxiety B. Giving the patient basic stress management activities C. Developing a plan together that is not overwhelming D. All of the above QUESTION 25 1 points 8 1. 2. 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. An elderly patient in a nursing home has been losing interest in activities and now refuses to leave his room. After a physical exam, he is referred to a PMHNP for an initial assessment. True or false: After speaking with the patient, an appropriate screening tool for the PMHNP to use would be the Geriatric Depression Scale. 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?” QUESTION 26 1 points True False QUESTION 27 1 points 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, 2. “He’ll be fine. He has mild depression.” Which of the following statement is correct related to confidentiality rights? 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 allowed to share information. D. The PMHNP’s response was ethical and legal because she was trying to answer the question. 1 points QUESTION 28 During a clinical assessment of a 15-year-old patient, the PMHNP asks, “How can I help you?” The patient answers by saying, “Honestly, I don’t really think I need any help.” Which of the following is the most appropriate response by the PMHNP? A. “That’s fine. Can you describe the depressive symptoms you’ve been having the past few months?” B. “Since you’re already here, maybe we can try to figure out if there is anything else I can help you with.” C. “You wouldn’t be here if you didn’t actually need help, right? So tell me, how can I be of assistance?” D. None of the above. QUESTION 29 1 points 9 1. 2. 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 statements made by the patient would verify the PMHNP’s suspicion? 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.” 2. 1. 2. 1. 2. 1. 2. D. “I believe in systems; I have to have order and rules in my everyday life. If a task must be completed, I will often complete it myself versus depending on someone else.” 1 points QUESTION 30 The patient attempts the PMHNP’s sleep hygiene recommendations for 2 weeks, but does not make any progress mitigating nightmares and hyperarousal. Which behavioral strategy does the PMHNP suggest next? A. Progressive muscle relaxation exercises B. Paradoxical interventions C. Biofeedback D. All of the above QUESTION 31 1 points 10 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? A. Emphasize the past B. Focus on expressions of emotion C. Identify patterns in relationships D. All of the above QUESTION 32 1 points The PMHNP is working with a 56-year-old man who is being seen because of his anxiety and depression. During the therapy sessions, the PMHNP assists the patient in discussing his experiences and expanding on his thoughts and feelings. He tells the PMHNP stories about how he used to be teased by his coworkers at the office for becoming too anxious in large conference rooms. The PMHNP listens to the patient and helps focus on his strengths to promote self-understanding. Which principle best accounts for the PMHNP’s interactions with the patient? A. Therapeutic communication B. Maintaining the frame C Working with resistance . D. None of the above QUESTION 33 1 points 11 1. 2. The PMHNP is conducting a peer review of another PMHNP’s medical charts. Upon review, the PMHNP notes that the peer often begins patient sessions late, as well as ends them later than scheduled. The PMHNP also found a comment in the chart regarding the patient sending text messages while in the middle of the session. Based on these findings, the feedback that the PMHNP will provide to the peer involves which therapeutic principle? A. Assessing safety B. Applying therapeutic communication C. Using empathy D. Maintaining the frame 32.The PMHNP is mentoring a student. After working with a patient during a session, the student laments about all the things she should have, or could have, said to the patient. “I feel guilty that I didn’t speak up more about the patient’s concern toward her son,” says the student. The PMHNP understands that the student is exhibiting signs of which therapeutic concept?