NUR7375900 PMHNP Acute and chronic management of adult with Psych
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Free NUR7375900 PMHNP Acute and chronic management of adult with Psych Questions
Phobia is defined as a fear.
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True
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False
Explanation
Correct Answer: (A) True
A phobia is defined as a persistent, excessive, and irrational fear of a specific object, situation, or activity. According to the DSM-5-TR, phobias are characterized by marked fear or anxiety about a specific stimulus that is out of proportion to the actual danger posed, leading to avoidance behavior and significant functional impairment.
Why Other Options are Incorrect:
B. False — This is incorrect. By clinical and dictionary definition, a phobia is indeed a type of fear — specifically one that is intense, persistent, and irrational in nature.
Major depressive disorder has many presentations in special populations. In older populations, it is well documented that complaints that are ______ are under-diagnosed cases of major depressive disorder.
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Somatic
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Generic
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Psychotic
Explanation
Explanation:
Correct Answer: (A) Somatic
In older adults, major depressive disorder frequently presents with somatic (physical) complaints such as fatigue, chronic pain, headaches, and gastrointestinal disturbances rather than the classic emotional symptoms of sadness or hopelessness. Clinicians often attribute these physical symptoms to comorbid medical conditions, leading to significant under-diagnosis of depression in the elderly population.
Why Other Options are Incorrect:
B. Generic — "Generic" is not a recognized clinical descriptor for symptom presentations in depression and holds no diagnostic relevance in this context.
C. Psychotic — While psychotic features can accompany severe depression, they are not the most commonly under-diagnosed presentation in older adults. Somatic complaints are far more prevalent and more frequently overlooked in this population.
Which of the following best distinguishes schizoaffective disorder from bipolar disorder with psychotic features?
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The presence of both manic and depressive episodes during the illness
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Psychotic symptoms that occur exclusively during mood episodes
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Psychotic symptoms that persist for at least 2 weeks without any mood symptoms
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A family history of both mood disorders and schizophrenia
Explanation
Correct Answer Is:
(C) Psychotic symptoms that persist for at least 2 weeks without any mood symptoms
The defining feature that distinguishes schizoaffective disorder from bipolar disorder with psychotic features is the presence of psychotic symptoms — such as delusions or hallucinations — that persist for at least 2 weeks in the absence of a major mood episode. In bipolar disorder with psychotic features, psychosis occurs only during mood episodes and resolves when the mood episode remits.
Why Other Options are Incorrect:
A. The presence of both manic and depressive episodes — Both schizoaffective disorder (bipolar type) and bipolar disorder with psychotic features can involve manic and depressive episodes, so this does not serve as a distinguishing criterion.
B. Psychotic symptoms that occur exclusively during mood episodes — This actually describes bipolar disorder with psychotic features, not schizoaffective disorder.
D. A family history of both mood disorders and schizophrenia — Family history may be informative but is not a DSM-5 diagnostic criterion that distinguishes these two disorders.
What neurotransmitter system is involved or implicated in depressive disorders?
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Monoamine neurotransmitter system
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Corticotropin-releasing system
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GABAergic system
Explanation
Correct Answer: A) Monoamine neurotransmitter system
The monoamine neurotransmitter system — encompassing serotonin, norepinephrine, and dopamine — is the most well-established system implicated in the pathophysiology of depressive disorders. The monoamine hypothesis of depression proposes that a deficiency or dysregulation of these neurotransmitters underlies depressive symptoms.
This is directly supported by the mechanism of most antidepressant medications, including SSRIs, SNRIs, and TCAs, which all target monoamine pathways to restore neurochemical balance. While the corticotropin-releasing system (HPA axis dysregulation) and GABAergic system have been studied in relation to depression, they are not the primary or most clinically established neurotransmitter systems used to explain and treat depressive disorders.
Which of the following best illustrates the defense mechanism "regression"?
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A college student, overwhelmed by exams, begins sleeping with a childhood stuffed animal for comfort.
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A man who cheats on his taxes accuses others of being dishonest.
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A woman who didn't get a job she wanted says the company wasn't good enough for her anyway.
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A person who witnesses a car accident forgets key details of the event.
Explanation
Explanation:
Correct Answer: (A) A college student, overwhelmed by exams, begins sleeping with a childhood stuffed animal for comfort.
Regression is a defense mechanism in which an individual reverts to behaviors characteristic of an earlier developmental stage when faced with stress or anxiety. The college student, overwhelmed by academic pressure, returns to a childhood comfort behavior — sleeping with a stuffed animal — as a way of coping with the current stressor.
Why Other Options are Incorrect:
B. A man who cheats on his taxes accuses others of being dishonest — This describes projection, where one's own unacceptable behavior or feelings are attributed to others.
C. A woman who didn't get a job says the company wasn't good enough for her anyway — This describes rationalization, where a logical-sounding justification is created to protect self-esteem from a painful outcome.
D. A person who witnesses a car accident forgets key details of the event — This describes repression or dissociation, where distressing memories or details are unconsciously excluded from awareness.
In schizophrenia, which of the following are negative symptoms commonly associated with schizophrenia?
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Hallucinations
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Delusions
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Flat affect
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Disorganized speech
Explanation
Correct Answer Is:
(C) Flat affect
Negative symptoms of schizophrenia refer to the diminution or absence of normal functions. Flat affect — a marked reduction in emotional expressiveness — is a classic negative symptom, along with alogia (poverty of speech), avolition (lack of motivation), anhedonia, and asociality. These symptoms reflect a loss of normal emotional and behavioral responsiveness.
Why Other Options are Incorrect:
A. Hallucinations — Hallucinations are positive symptoms of schizophrenia, representing an addition of abnormal experiences not present in healthy individuals.
B. Delusions — Delusions are also positive symptoms, characterized by fixed false beliefs that are resistant to reasoning or contrary evidence.
D. Disorganized speech — Disorganized speech is a positive symptom reflecting disrupted thought processes, not a negative symptom of schizophrenia.
Bipolar affective disorder is a mood disorder generally first diagnosed as major depressive disorder. The PMHNP knows that the DSM-5-TR differentiates between major depressive unipolar versus bipolar 1 disorder by criterion of hypomanic episodes and mood fluctuations. One of the main criterions is the quantity of sleep or insomnia triggering either hypomania or mania. The PMHNP knows that with bipolar 1 disorder, the client will experience insomnia that may last for ______ hours per night, and the client will report they "do not miss the sleep, with good energy or high energy." This may be the beginning of a hypo or manic episode. How many hours of sleep is indicated for "poor sleep 4 to 7 nights in a row?" Choose the best answer below.
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5 hours
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8 hours
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3 hours
Explanation
Explanation:
Correct Answer: (C) 3 hours
In bipolar 1 disorder, a hallmark criterion for a manic or hypomanic episode is a dramatically decreased need for sleep — typically as little as 3 hours per night — without the individual feeling fatigued or rested. This distinguishes it from insomnia, where the person desires sleep but cannot achieve it. A patient reporting sustained high energy and functioning on only 3 hours of sleep over 4 to 7 consecutive nights is a critical clinical indicator of an emerging manic episode requiring prompt evaluation.
Why Other Options are Incorrect:
A. 5 hours — While reduced, 5 hours does not meet the clinical threshold that characterizes the severely decreased need for sleep seen in bipolar 1 mania or hypomania.
B. 8 hours — Eight hours represents a normal, healthy sleep duration and has no clinical significance in the context of manic episode criteria.
When the PMHNP is assessing the differential diagnosis of frontotemporal versus lewy body versus dementia with Picks disease, the best collaboration is refer to _______.
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Internal medicine
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Neurology
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Infectious disease
Explanation
Correct Answer: (B) Neurology When differentiating between complex neurocognitive disorders such as frontotemporal dementia, Lewy body dementia, and Pick's disease, the most appropriate and effective collaboration is a referral to neurology. Neurologists specialize in the diagnosis and management of neurodegenerative conditions and have access to specialized diagnostic tools including neuroimaging, neuropsychological testing, and cerebrospinal fluid analysis needed to accurately differentiate between these complex conditions.
Why Other Options are Incorrect:
A. Internal medicine — While internists provide comprehensive general medical care and may initially evaluate cognitive complaints, they do not have the specialized expertise required to differentiate between complex neurodegenerative conditions such as frontotemporal dementia, Lewy body dementia, and Pick's disease.
C. Infectious disease — Infectious disease specialists are consulted for conditions caused by infectious agents such as bacteria, viruses, fungi, and parasites. Frontotemporal dementia, Lewy body dementia, and Pick's disease are neurodegenerative disorders, not infectious conditions, making infectious disease consultation inappropriate for this differential diagnosis.
The PMHNP is interviewing a 26-year-old male with a history of major depressive disorder. The client reports, "depression is not much better." The PMHNP knows this visit may be ___ for ___. Fill in the blank with the best answers below.
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visit for medication
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risk for suicide
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visit for therapy
Explanation
Correct Answer: B) risk for suicide
When a client with major depressive disorder reports that their depression is "not much better," this is a critical red flag that must be assessed for suicide risk immediately. Worsening or unremitting depression is one of the strongest predictors of suicidal ideation and attempt. The PMHNP's priority in this encounter is to conduct a thorough suicide risk assessment — including asking directly about thoughts of self-harm, plans, means, and intent — before addressing medication changes or therapy goals. In psychiatric nursing, any statement suggesting the treatment is not working must be interpreted through the lens of patient safety first.
Which of the following is an example of the defense mechanism "projection" as described by Freud?
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A student who forgets an exam date insists the teacher never announced it.
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A person who is angry at their boss insists that their boss is actually angry at them.
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After being scolded by a parent, a child begins sucking their thumb again.
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A person refuses to accept that their partner has ended the relationship.
Explanation
Correct Answer: B) A person who is angry at their boss insists that their boss is actually angry at them.
Projection is a defense mechanism in which an individual attributes their own unacceptable thoughts, feelings, or impulses onto another person. In this example, the person cannot consciously acknowledge their own anger toward their boss, so they instead perceive the boss as being angry at them — effectively projecting their internal emotional state outward onto someone else. Option A describes rationalization, where an excuse is made to justify a lapse. Option C describes regression, where a person reverts to earlier, more childlike behaviors under stress. Option D describes denial, where an individual refuses to accept a painful reality.
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