NURS6670 Psychiatric Mental Health Nurse Practitioner Role II
Week 2 Assignment 1
“Captain of the Ship” Project – Depressive
Disorder
As nurse
practitioners strive to achieve full-autonomous practice across the country, it
should be noted that many states grant this ability to practice independently
to psychiatric mental health nurse practitioners. To that end, you will be
engaging in projects this semester that assume that you are practicing in a
state that allows full-practice authority for NPs, meaning that the PMHNP may
be the “captain of the ship” concerning caring for a patient population. The
“captain of the ship” is the one who makes referrals to specialists, coordinates
care for their patients/clients, and is responsible and accountable for
patient/client outcomes overall. This is a decided change from a few decades
ago when physicians were the “captain of the ship” and NPs played a peripheral
role.
In this
Assignment, you will become the “captain of the ship” as you provide treatment
recommendations and identify medical management, community support resources,
and follow-up plans for a client with a depression disorder.
Learning
Objectives
Students
will:
• Recommend psychopharmacologic
treatments based on therapeutic endpoints for clients with depression disorders
• Recommend psychotherapy based on
therapeutic endpoints for clients with depression disorders
• Identify medical management needs
for clients with depression disorders
• Identify community support
resources for clients with depression disorders
• Recommend follow-up plans for
clients with depression disorders
To prepare
for this Assignment:
• Select an adult or older adult
client with a depressive disorder you have seen in your practicum.
In 3–4
pages, write a treatment plan for your client in which you do the following:
• Describe the HPI and clinical
impression for the client.
• Recommend psychopharmacologic
treatments and describe specific and therapeutic endpoints for your
psychopharmacologic agent. (This should relate to HPI and clinical impression.)
• Recommend psychotherapy choices
(individual, family, and group) and specific therapeutic endpoints for your
choices.
• Identify medical management needs,
including primary care needs, specific to this client.
• Identify community support
resources (housing, socioeconomic needs, etc.) and community agencies that are
available to assist the client.
• Recommend a plan for follow-up
intensity and frequency and collaboration with other providers.
By Day 7
Submit your
Assignment.
Submission
and Grading Information
To submit
your completed Assignment for review and grading, do the following:
• Please save your Assignment using
the naming convention “WK2Assgn1+last name+first initial.(extension)” as the
name.
• Click the Week 2 Assignment 1
Rubric to review the Grading Criteria for the Assignment.
• Click the Week 2 Assignment 1 link.
You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area,
click on the Browse My Computer button. Find the document you saved as
“WK2Assgn1+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism
Tools area, click the checkbox for I agree to submit my paper(s) to the Global
Reference Database.
• Click on the Submit button to complete your submission.

NURS6670 Psychiatric Mental Health Nurse Practitioner Role II
Week 1 Discussion
Interview
Format
Despite
what you may believe (or may have been told), there is no such thing as one
“right” way to do an interview. In fact, there are numerous books written about
the various ways of conducting the clinical interview. In actual clinical
practice, you will find the format that “works” best for you and addresses your
unique strengths and the needs of the client.
In this
Discussion, you will practice finding the interview format that works for you
and share those ideas with your colleagues for feedback.
Learning
Objectives
Students
will:
• Develop
formats for initial interviews of mental health clients
Note: For
this Discussion, you are required to complete your initial post before you will
be able to view and respond to your colleagues’ postings. Begin by clicking on
the “Post to Discussion Question” link and then select “Create Thread” to
complete your initial post. Remember, once you click submit, you cannot delete
or edit your own posts and cannot post anonymously. Please check your post
carefully before clicking Submit!
To prepare
for this Discussion:
• Review
the Learning Resources.
• Develop
an interview format you would use for an initial interview of a client.
• Attach
the interview format document you would use for an initial interview of a
client.
• Describe
what interview format your preceptor uses for the initial interview of a
client.
• Describe
which element of your interview format is most helpful in your practice.
By Day 6
Respond to
at least two of your colleagues by constructively critiquing their interview
format and providing feedback.
NURS6670 Psychiatric Mental Health Nurse Practitioner Role II
Week 3 Discussion
Treatment
of Personality Disorders
Personality
disorders occur in 10–20% of the population. They are difficult to treat as
individuals with personality disorders are less likely to seek help than
individuals with other mental health disorders. Treatment can be challenging as
they do not see their symptoms as painful to themselves or others.
In this
Discussion, you will explore personality disorders in greater detail and
discuss treatment options using evidence-based research.
Learning
Objectives
Students
will:
• Analyze diagnostic criteria for
personality disorders
• Analyze evidence-based
psychotherapy and psychopharmacologic treatments for personality disorders
• Analyze clinical features of
clients with personality disorders
• Align clinical features with DSM-5
criteria
• Compare differential diagnostic
features of personality disorders
Note: For
this Discussion, you are required to complete your initial post before you will
be able to view and respond to your colleagues’ postings. Begin by clicking on
the “Post to Discussion Question” link and then select “Create Thread” to
complete your initial post. Remember, once you click submit, you cannot delete
or edit your own posts, and cannot post anonymously. Please check your post
carefully before clicking Submit!
To prepare
for this Discussion:
• By Day 5 of Week 2, your Instructor
will have assigned you a personality disorder, which will be your focus for
your initial post for this Discussion.
• Review the Learning Resources.
By Day 3
Post:
• Explain the diagnostic criteria for
your assigned personality disorder.
• Explain the evidenced-based
psychotherapy and psychopharmacologic treatment for your assigned personality
disorder.
• Describe clinical features from a
client that led you to believe this client had this disorder. Align the
clinical features with the DSM-5 criteria.
• Support your rationale with
references to the Learning Resources or other academic resources.
By Day 6
Respond to
at least two of your colleagues by comparing the differential diagnostic
features of the disorder you were assigned to the diagnostic features of the
disorder your colleagues were assigned. What are their similarities and
differences? How might you differentiate the two diagnoses?
NURS6670 Psychiatric Mental Health Nurse Practitioner Role II
Week 4 Discussion
Clinical
Supervision – Kaltura
Substance
use disorders are complicated psychiatric and medical conditions that involve
physical addiction as well as psychological or emotional dependence. Substance
use disorders are some of the most difficult to treat. It takes a great deal of
patience on the part of the provider and the client. It may take several
attempts before a client is successfully able to “kick the habit.” Your
guidance and patience can help the client to persevere through difficult times
during the journey to recovery.
Clinical
Supervision is an essential component of your development as a psychiatric
mental health nurse practitioner. It provides an opportunity for professional
collaboration as you share experiences with and gain insights from colleagues.
For this Clinical Supervision, consider a client with a substance abuse
disorder whom you do not think is adequately progressing according to expected
clinical outcomes.
Learning
Objectives
Students
will:
• Analyze clients presenting for
treatment of substance-related and addictive disorders
• Evaluate effectiveness of
therapeutic approaches for clients diagnosed with substance-related and
addictive disorders
• Recommend treatment plans
Note: For
this Discussion, you are required to complete your initial post before you will
be able to view and respond to your colleagues’ postings. Begin by clicking on
the “Post to Discussion Question” link and then select “Create Thread” to
complete your initial post. Remember, once you click submit, you cannot delete
or edit your own posts, and cannot post anonymously. Please check your post
carefully before clicking Submit!
To prepare
for this Discussion:
• Review this week’s Learning
Resources concerning treating patients with substance-related and addictive
disorders.
• Reflect on a client you are
currently counseling or have previously counseled at your practicum site who
has been diagnosed with substance-related and addictive disorders.
By Day 3
Post a 3-
to 5-minute Kaltura video in which you do the following:
• Describe the client. Note: Do not
use the client’s actual name.
• Explain your therapeutic approach
with the client, including the perceived effectiveness of your approach.
• Identify any additional information
about this client that may potentially impact expected outcomes.
• Provide specific recommendations
for the client to help them in determining why they are not progressing and
what your suggested treatment plan consists of. It is useful to consult the
Prochaska and DiClement model.
Note: Nurse
practitioners must have strong oral communication skills. This Discussion is
designed to help you hone these skills. When filming your Kaltura video, be
sure to dress and speak in a professional manner.
View a
selection of your colleagues’ responses.
By Day 6
Respond to
at least two of your colleagues by suggesting an alternate therapeutic
approach. Support your feedback with evidence-based literature and/or your own
experiences with clients.
NURS6670 Psychiatric Mental Health Nurse Practitioner Role II
Week 6 Discussion
Treatment
of Anxiety Disorders
Anxiety
disorders are common in both primary care and psychiatric practice. Clients
with anxiety disorders including generalized anxiety disorders, agoraphobia,
and other specific phobias will present to the PMHNP’s office with a
significant level of distress. Successful recognition and treatment of anxiety
disorders includes an accurate diagnostic assessment with a treatment plan that
includes a combination of psychopharmacology and psychotherapy. Although
psychoanalytic theories are based on the concept of anxiety, the more recent
standard of care is with the cognitive-behavioral therapies.
In this
Discussion, you will analyze evidence-based treatment plans for clients with
anxiety disorders.
Learning
Objectives
Students
will:
• Analyze differences between
adjustments disorders and anxiety disorders
• Analyze diagnostic criteria for
anxiety disorders
• Analyze evidence-based
psychotherapy and psychopharmacologic treatment for anxiety disorders
• Compare differential diagnostic
features of anxiety disorders
Note: For
this Discussion, you are required to complete your initial post before you will
be able to view and respond to your colleagues’ postings. Begin by clicking on
the “Post to Discussion Question” link and then select “Create Thread” to
complete your initial post. Remember, once you click submit, you cannot delete
or edit your own posts and cannot post anonymously. Please check your post
carefully before clicking Submit!
To prepare
for this Discussion:
• By Day 5 of Week 5, your Instructor
will have assigned you an anxiety disorder, which will be your focus for your
initial post for this Discussion.
• Review the Learning Resources.
By Day 3
Post:
• Explain the difference between an
adjustment disorder and anxiety disorder. Provide examples to illustrate your
rationale.
• Explain the diagnostic criteria for
your assigned anxiety disorder.
• Explain the evidenced-based
psychotherapy and psychopharmacologic treatment for your assigned anxiety
disorder.
• Support your rationale with
references to the Learning Resources or other academic resource.
By Day 6
Respond to
at least two of your colleagues by comparing the differential diagnostic
features of the disorder you were assigned to the diagnostic features of the
disorder your colleagues were assigned.
NURS6670 Psychiatric Mental Health Nurse Practitioner Role II
Week 8 Discussion
Treatment
of Neurocognitive Disorders
Neurocognitive
disorders (NCD) such as delirium, dementia, and amnestic disorders are more
prevalent in older adults. As the population ages and as life expectancy in the
United States continues to increase, the incidence of these disorders will
continue to increase. Cognitive functioning such as memory, language,
orientation, judgment, and problem solving are affected in clients with NCDs.
Caring for someone with a neurocognitive disorder is not only challenging for
the clinician, but also stressful for the family. The PMHNP needs to consider
not only the client but also the “family as client.” Collaboration with primary
care providers and specialty providers is essential. Anticipatory guidance also
becomes extremely important.
In this
Discussion, you will integrate several sources of knowledge specific to NCDs as
you discuss evidenced-based therapies used to treat these disorders.
Learning
Objectives
Students
will:
• Analyze diagnostic criteria for
neurocognitive disorders
• Analyze evidence-based psychotherapy
and psychopharmacologic treatment for neurocognitive disorders
• Evaluate benefits and risks of
neurocognitive therapies
• Compare differential diagnostic
features of neurocognitive disorders
Note: For
this Discussion, you are required to complete your initial post before you will
be able to view and respond to your colleagues’ postings. Begin by clicking on
the “Post to Discussion Question” link and then select “Create
Thread” to complete your initial post. Remember, once you click submit,
you cannot delete or edit your own posts, and cannot post anonymously. Please
check your post carefully before clicking Submit!
To prepare
for this Discussion:
• By Day 5 of Week 7, your Instructor
will have assigned you a neurocognitive disorder, which will be the focus for
your initial post for this Discussion.
• Review the Learning Resources.
By Day 3
Post:
• Explain the diagnostic criteria for
your assigned neurocognitive disorder.
• Explain the evidenced-based
psychotherapy and psychopharmacologic treatment for your assigned
neurocognitive disorder.
• Identify the risks of different
types of therapy and explain how the benefits of the therapy that might be achieved
might outweigh the risks.
• Support your rationale with
references to the Learning Resources or other academic resource.
By Day 6
Respond to
at least two of your colleagues by comparing the differential diagnostic
features of the disorder you were assigned to the diagnostic features of the
disorder your colleagues were assigned.
NURS6670 Psychiatric Mental Health Nurse Practitioner Role II
Week 10 Discussion
Treatment
of Sleep/Wake Disorders
The power
of sleep to heal the body cannot be underestimated. Most research indicates
that 7–8 hours of sleep are a minimum that people need to stay healthy. Clients
who come to the PMHNP’s office frequently complain of sleep problems. It is
estimated that 10–20% of patients report some type of sleeping problem.
In this
Discussion, you will analyze the diagnostic criteria and evidence-based
psychotherapy and psychopharmacologic treatment for sleep/wake disorders.
Learning
Objectives
Students
will:
• Analyze diagnostic criteria for
sleep/wake disorders
• Analyze evidence-based
psychotherapy and psychopharmacologic treatment for sleep/wake disorders
• Analyze criteria for referring
clients to primary care physicians for treatment of sleep/wake disorders
• Compare differential diagnostic
features of sleep/wake disorders
Note: For
this Discussion, you are required to complete your initial post before you will
be able to view and respond to your colleagues’ postings. Begin by clicking on
the “Post to Discussion Question” link and then select “Create Thread” to
complete your initial post. Remember, once you click submit, you cannot delete
or edit your own posts, and cannot post anonymously. Please check your post
carefully before clicking Submit!
To prepare
for this Discussion:
• By Day 5 of Week 9, your Instructor
will have assigned you a sleep/wake disorder, which will be the focus of your
original post for this Discussion.
• Review the Learning Resources.
• Explain the diagnostic criteria for
your assigned sleep/wake disorder.
• Explain the evidenced-based
psychotherapy and psychopharmacologic treatment for your assigned sleep/wake
disorder.
• Describe at what point you would
refer the client to their primary care physician for an additional referral to
a neurologist, pulmonologist, or physician specializing in sleep disorders and
explain why.
• Support your rationale with
references to the Learning Resources or other academic resource.
By Day 6
Respond to
at least two of your colleagues by comparing the differential diagnostic
features of the disorder you were assigned to the diagnostic features of the
disorder your colleagues were assigned.
NURS6670 Psychiatric Mental Health Nurse Practitioner Role II
Week 11 Discussion
Assessment
and Treatment of Gender Dysphoria, Paraphilic Disorders, and Sexual Dysfunction
Sexuality
is an important part of each person’s quality of life. Research indicates that
awareness of sexual identity and its importance may begin as early as age 3.
However, individuals with varying diagnoses, disorders, or dysfunctions may
grapple with issues related to their sexuality in their teen years, as well as
into adulthood.
In this
Discussion, you will explore the assessment and treatment of gender dysphoria,
paraphilic disorders, and sexual dysfunction.
Learning
Objectives
Students
will:
• Analyze diagnostic criteria for
gender dysphoria, paraphilic disorders and sexual dysfunction
• Analyze evidence-based
psychotherapy and psychopharmacologic treatments for gender/sexual disorders
• Compare differential diagnostic
features of gender/sexual disorders
Note: For
this Discussion, you are required to complete your initial post before you will
be able to view and respond to your colleagues’ postings. Begin by clicking on
the “Post to Discussion Question” link and then select “Create Thread” to complete
your initial post. Remember, once you click submit, you cannot delete or edit
your own posts, and cannot post anonymously. Please check your post carefully
before clicking Submit!
To prepare
for this Discussion:
• Select a gender dysphoria, paraphilic
disorder, or sexual dysfunction that interests you.
• Review the Learning Resources.
By Day 3
Post:
• Explain the diagnostic criteria for
the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected.
• Explain the evidenced-based psychotherapy
and psychopharmacologic treatment for the gender dysphoria, paraphilic
disorder, or sexual dysfunction you selected.
• Support your rationale with
references to the Learning Resources or other academic resource.
By Day 6
Respond to
at least two of your colleagues by comparing the differential diagnostic
features of the disorder you selected to the diagnostic features of the
disorder your colleagues were assigned.
Submission and Grading Information

NURS6670 Psychiatric Mental Health Nurse Practitioner Role II
Week 11 Discussion
Assessment
and Treatment of Gender Dysphoria, Paraphilic Disorders, and Sexual Dysfunction
Sexuality
is an important part of each person’s quality of life. Research indicates that
awareness of sexual identity and its importance may begin as early as age 3.
However, individuals with varying diagnoses, disorders, or dysfunctions may
grapple with issues related to their sexuality in their teen years, as well as
into adulthood.
In this
Discussion, you will explore the assessment and treatment of gender dysphoria,
paraphilic disorders, and sexual dysfunction.
Learning
Objectives
Students
will:
• Analyze diagnostic criteria for
gender dysphoria, paraphilic disorders and sexual dysfunction
• Analyze evidence-based
psychotherapy and psychopharmacologic treatments for gender/sexual disorders
• Compare differential diagnostic
features of gender/sexual disorders
Note: For
this Discussion, you are required to complete your initial post before you will
be able to view and respond to your colleagues’ postings. Begin by clicking on
the “Post to Discussion Question” link and then select “Create Thread” to complete
your initial post. Remember, once you click submit, you cannot delete or edit
your own posts, and cannot post anonymously. Please check your post carefully
before clicking Submit!
To prepare
for this Discussion:
• Select a gender dysphoria, paraphilic
disorder, or sexual dysfunction that interests you.
• Review the Learning Resources.
By Day 3
Post:
• Explain the diagnostic criteria for
the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected.
• Explain the evidenced-based psychotherapy
and psychopharmacologic treatment for the gender dysphoria, paraphilic
disorder, or sexual dysfunction you selected.
• Support your rationale with
references to the Learning Resources or other academic resource.
By Day 6
Respond to
at least two of your colleagues by comparing the differential diagnostic
features of the disorder you selected to the diagnostic features of the
disorder your colleagues were assigned.
Submission and Grading Information

Week_5_Assignment_1_“Captain_of_the_Ship”_Project_–_Bipolar_Disorders.docx (17.25 KB)

NURS6670 Psychiatric Mental Health Nurse Practitioner Role II
Week 5 Assignment 1
Assignment
1: “Captain of the Ship” Project – Bipolar Disorders
Bipolar
disorders are severe disorders of mood that include both depressive episodes
and expansive, grandiose, or manic episodes. During these times, the person may
engage in activities with little awareness of the consequences because of
accompanying psychosis. A diagnosis of bipolar disorder includes periods of
mania or hypomania and periods of depression where the mood is down, hopeless,
and suicidal. The neurovegetative symptoms of bipolar depression can be
incapacitating. It is also important to differentiate the psychosis of bipolar
disorder from schizophrenia.
In this
Assignment, you will become the “captain of the ship” as you provide treatment
recommendations and identify medical management, community support resources,
and follow-up plans for a client with a bipolar disorder.
Learning
Objectives
Students
will:
• Recommend psychopharmacologic
treatments based on therapeutic end points for clients with bipolar disorders
• Recommend psychotherapy based on
therapeutic end points for clients with bipolar disorders
• Identify medical management needs
for clients with bipolar disorders
• Identify community support
resources for clients with bipolar disorders
• Recommend follow-up plans for
clients with bipolar disorders
To prepare
for this Assignment:
• Select an adult or older adult
client with a bipolar disorder that you have seen in your practicum.
In 3-4
pages, write a treatment plan for your client. In which you do the following:
• Describe the HPI and clinical
impression for the client.
• Recommend psychopharmacologic
treatments and describe specific and therapeutic end points for your
psychopharmacologic agent. (This should relate to HPI and clinical
impression.).
• Recommend psychotherapy choices
(individual, family, and group) and specific therapeutic endpoints for your
choices.
• Identify medical management needs,
including primary care needs, specific to this client.
• Identify community support
resources (housing, socioeconomic needs, etc.) and community agencies that are
available to assist the client.
• Recommend a plan for follow-up
intensity and frequency and collaboration with other providers.
By Day 7
Submit your
Assignment.
Submission
and Grading Information
To submit
your completed Assignment for review and grading, do the following:
• Please save your Assignment using
the naming convention “WK5Assgn1+last name+first initial.(extension)” as the
name.
• Click the Week 5 Assignment 1
Rubric to review the Grading Criteria for the Assignment.
• Click the Week 5 Assignment 1 link.
You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area,
click on the Browse My Computer button. Find the document you saved as
“WK5Assgn1+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism
Tools area, click the checkbox for I agree to submit my paper(s) to the Global
Reference Database.
• Click on the Submit button to complete your submission.

Walden_NURS6003_Quiz_Week_1.docx (20.61 KB)

Question 1 Students can always edit their posting in
Discussion.
True
False
Question 2 In which area will you retrieve written
assignments with comments from your instructor?
A.
Discussion
B.
My grades area
C.
Assignment Link
Question 3 Where in your online course will you find the
contact information for your Instructor?
A.Syllabus
B.Student Support
C.Contact the Instructor
Question 4 Who should you contact with questions about online
classroom technical concerns?
A.Your Instructor
B.Walden Academic Advisor
C.Student Support
D.Program Director
Question 5 When sending an e-mail to your Instructor or any
Walden staff, your e-mail should:
A.Include color stationary as a background
B.USE ALL CAPITAL LETTERS SO THEY KNOW YOUR EMAIL IS
IMPORTANT
C.Include your full legal name, your program or course, and
your Walden ID Number
Question 6 If you are having trouble accessing your online
classroom, what should you do first?
A.Clean your browser’s cookies and cache
B.Check firewall settings
C.Deactivate pop-up blockers
Question 7 When will you lose access to your completed
courses (excluding this Student Readiness Orientation)?
A.Never
B.30 days after the course end date
C.60 days after the course end date
D.120 days after the course end date
Question 8 In an online course, students can participate in
the online classroom and submit assignments whenever it is convenient for them
to do so.
True
False
Question 9 The online classroom area where you can post an
assignment and have your classmates and instructor respond to your ideas is
called:
My Grades area
Discussion
Assignment Link
Question 10 If you have a question about which courses you should
register for next term, who should you contact?
A.Student Support Team
B.One of your current instructors
C.Your Academic Advisor

NURS_6550_FINAL_EXAM.docx (449.71 KB)

QUESTION 1
1. Mr. Jeffers was admitted 2 days ago for carotid endarterectomy. A Foley catheter
was inserted intraoperatively and remains in place. His urine output has
declined markedly despite continued IV fluid infusion. Today his morning labs
reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A leading differential
includes:
A. Foley lodged in the urethra causing post-renal failure
B. Decreased renal perfusion causing prerenal failure
C. Age-related decreased eGFR causing prerenal failure
D. Post-surgical rhabdomyolysis causing intrarenal failure
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 2
1. Janet is admitted with symptomatic tachycardia. Her pulse is 160 b.p.m. and she is weak,
diaphoretic, and anxious. Physical examination reveals a 5’4” 107 lb black
female who is awake, alert, and oriented, anxious, with moist skin and racing
pulse. Her blood pressure is 140/100 mm Hg. Temperature and respiratory rate
are within normal limits. The patient admits to having a “thyroid condition”
but she never followed up on it when she was advised to see an endocrinologist.
The AGACNP anticipates a diagnosis of:
A. Hashimoto’s thyroiditis
B. Cushing’s syndrome
C. Grave’s disease
D. Addison’s disease
1 points

QUESTION 3
1. Systemic
lupus erythematosis (SLE) is a multi-organsystem autoimmune disorder that can
prevent with a wide variety of manifestations. Which clinical triad should
prompt an evaluation for SLE?
A. Fever, normal white count, elevated sedimentation rate
B. Hyperkalemia, hyponatremia, low blood pressure
C. Leukocytosis, hyperglycemia, hypokalemia
D. Joint pain, rash, fever
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 4
1. A patient presents with profound vertigo of acute onset yesterday. She can barely turn
her head without becoming very vertiginous; she is nauseous and just doesn’t
want to move. This morning when she tried to get out of bed she felt like she
was pushed back down. The vertigo is reproducible with cervical rotation. The
patient denies any hearing loss or tinnitus, she has no fever or other
symptoms. The AGACNP knows that the most helpful intervention will probably be:
A. Meclizine
B. Diazepam
C. Bed rest
D. Epley’s
maneuvers
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 5
1. Mrs. Mireya is an 85-year-old female who is admitted for evaluation of acute mental
status change from the long term care facility. She is normally ambulatory and
participates in lots of facility activities. Today a nursing assistant found
her in her room, appearing confused and disconnected from her environment. When
she tried to get up she fell down. Her vital signs are stable excepting a blood
pressure of 90/60 mm Hg. The AGACNP knows that the most likely cause of her
symptoms is:
A. Osteoarthritis
B. Drug or alcohol toxicity
C. Hypotension
D. Urosepsis
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 6
1. A patient
with SIADH would be expected to demonstrate which pattern of laboratory
abnormalities?
A. Serum Na+
119 mEq/L, serum osmolality 240 mEq/L, urine Na+ of 28 mEq/L, urine osmolality
of 900 mOsm/kg
B. Serum Na+
152 mEq/L, serum osmolality 315 mEq/L, urine Na+ of 5 mEq/L, urine osmolality
of 300 mOsm/kg
C. Serum Na+
121 mEq/L, serum osmolality 290 mEq/L, urine Na+ of 7 mEq/L, urine osmolality
of 850 mOsm/kg
D. Serum Na+
158 mEq/L, serum osmolality 251 mEq/L, urine Na+ of 20 mEq/L, urine osmolality
of 420 mOsm/kg
1 points
QUESTION 7
1. Sean is a
29-year-old male who presents to the emergency department for evaluation and
treatment of foreign body in the eye. Ophthalmic anesthesia is achieved and removal
is attempted unsuccessfully with a moist cotton tipped swab. A wet fluorescein
stain is applied to the lower eyelid, and a corneal abrasion ruled out but the
AGACNP notes a positive Seidel sign. This indicates:
A. Penetration
of the cornea with resultant aqueous leak
B. A rust
ring remnant due to metal foreign body
C. An
elevated intraocular pressure
D. Paradoxical
pupil dilation in response to light
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 8
1. Mrs. Lowen is an 82-year-old female who comes to the emergency department for
evaluation of a fever of 102.9° F. She complains of a headache in the right
side of her temple and some right-sided jaw pain. A urinalysis, chest
radiograph, complete blood count (CBC) and 12-lead ECG are all
non-contributory. A comprehensive metabolic panel is significant only for a
slightly elevated BUN and creatinine. The AGACNP appreciates distinct right
temple tenderness to percussion. Which laboratory test is necessary to support
the suspected diagnosis?
A. An erythrocyte sedimentation rate
B. A white blood cell differential
C. Two sets of blood cultures
D. Echocardiography
1 points
QUESTION 9
1. Ms. Schiebel, a 31-year-old female who is brought to the emergency department by
police after being arrested for disruptive behavior in a public establishment.
The differential diagnosis includes drug and alcohol ingestion/toxicity,
central nervous system disease, severe trauma, and psychotic illness;
ultimately the alcohol and toxicology screen as well as head imaging are
negative. When considering psychotic illness, the AGACP knows that this is a
physiologic imbalance that typically involves an excess of:
A. Serotonin
B. Norepinephrine
C. Acetylcholine
D. Dopamine
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 10
1. Mr.
Lincoln is a 55-year-old male who was admitted for management of sepsis
secondary to pneumonia. He has declined rapidly, and today chest radiography
demonstrates a diffuse, bilateral “white-out” appearance. His paO2 is 55 mm Hg.
In order to increase his oxygenation the AGACNP knows that which of the
following interventions is indicated?
A. Increased
FiO2
B. Increased
respiratory rate
C. Increased
tidal volume
D. Increased
PEEP
1 points
QUESTION 11
1. A
29-year-old female patient presents with a complaint of palpitations. Physical
examination reveals an essentially healthy female with no significant medical
history and no maintenance medications; the only thing she can report is that
she had a head cold a week or so ago. The vital signs include a blood pressure
of 139/90 mm Hg, pulse of 105 b.p.m, respiratory rate of 16 b.p.m. and a
temperature of 98.6° F. The only abnormal finding on physical examination is
diffuse anterior neck tenderness with thyroid palpation. The AGACNP considers
which medication for symptom control?
A. Ibuprofen
B. Pseudoephedrine
C. Propranolol
D. Methimazole
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 12
1. Jennifer
is an 18-year-old homeless female who was found unresponsive. She was admitted
to the hospital for management of severe bleeding after a spontaneous abortion
escalated to a uterine hemorrhage. An underlying infection and dehydration were
corrected and nutritional supplements were started. Her volume status is
stable, morning labs were all within normal limits and she is to be discharged
today. When the AGACNP enters the room to prepare the patient for discharge,
she finds her agitated, pale, and diaphoretic with vital signs to include a
pulse of 105 bpm, respirations of 24 bpm, blood pressure of 110/76 mm Hg and a
temperature is 97.9° F. The most appropriate action would be to:
A. Order a
CBC to assess for recurrent bleeding
B. Request
and abdominal CT to assess for bleeding
C. Evaluate
the patient for anxiety/panic attack
D. Prescribe
alprazolam 1 mg now
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 13
1. Physical
examination findings in a patient with pneumothorax is likely to reveal:
A. Increased
tactile fremitus
B. Low grade
temperature
C. Hyperresonance
to percussion
D. Egophany
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 14
1. Mr.
Parker brings his 73-year-old wife to a clinic appointment because he is
worried about her. She has a long history of hypertension and dyslipidemia, but
he says she has taken medication for years and everything has been OK. His
concern today is that for a long time she has been very forgetful, and he has
tried to help her by keeping a strict routine around the house. Over the past
few months, she just seems more and more forgetful, does not seem interested in
doing anything, and now seems to be forgetting how to do simple everyday tasks.
Yesterday she could not figure out which dollar bills to use at the store to
pay the cashier. The AGACNP knows Mrs. Parker should first be screened for:
A. Depression
B. A brain
tumor
C. Hypothyroidism
D. Adrenal
dysfunction
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 15
1. M.R. is a
40-year-old female who has a known history of peptic ulcer disease. She has
been admitted through the emergency room with a diagnosis of GI bleeding—she is
vomiting dark blood and had a nasogastric tube placed. When attached to low
intermittent suction it initially drained 400 cc of dark brown/black drainage,
but now it is starting to drain lighter red colored blood. The AGACNP knows
that immediate priorities of care include:
A. Ensuring
hemodynamic stability
B. Beginning
a parenteral proton pump inhibitor
C. Beginning
gastric lavage
D. Ordering
a gastrointestinal consult
1 points
QUESTION 29
1. C.L. is a
48-year-old female who presents complaining of activity intolerance. She is
usually very active and fit^. She jogs regularly and typically does 4-5 miles a
day. About a week ago she became so tired she had to stop, and lately she has
become aware of becoming easily fatigued while going up and down stairs. She
admits that she thinks she is beginning menopause—she is having a lot of
bleeding with her periods, and her periods seem to be more frequent. A complete
blood count (CBC) reveals the following results:
Hgb 10.1 g/dL
Hct 30%
MCV 75 fL
RDW 21%
The AGACNP orders which of the following laboratory test to
confirm the suspected diagnosis?
A. Vitamin
B12
B. Folate
C. Ferritin
D. Hemoglobin
electrophoresis
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 30
1. Kevin H.
is a 61-year-old male who presents for treatment of profound anxiety. He has
been treated on and off for years—most recently he was taking escitalopram 20
mg p.o. daily, and although he does admit to some improvement, he still cannot
function appropriately thoughout the day. He has been counseled about poor work
performance and is concerned about losing his job, but he is just so worried
all of the time he cannot concentrate on work. The AGACNP knows that the most
appropriate action is to:
A. Increase
the dose of escitalopram to 40 mg daily
B. Refer
Kevin for a psychiatric consultation
C. Stop
escitalopram and begin venlafaxine
D. Discuss
therapeutic expectations with Kevin
1 points
QUESTION 31
1. When
examining a patient with a skin presentation suggestive of necrotizing
fasciitis, the AGACNP knows that the most important and sensitive diagnostic
test is:
A. A
complete blood count
B. Plain
film radiographs
C. The
finger test
D. CT scan
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 32
1. While
evaluating a patient with abdominal pain, the AGACP knows that when the pain is
described as coming in waves or cycles, with periods of relief in between, the
cause likely centers around:
A. Peristalsis
of bowel
B. Disorders
of pelvic organs
C. Organ
inflammation
D. Hyperacidity
1 points
QUESTION 33
1. Which of
the following findings is not typically associated with testicular torsion?
A. Acute
pain
B. Edema
C. High
riding testis
D. Dysuria
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 34
1. 152: When
completing this exam, did you comply with Walden University’s Code of Conduct
including the expectations for academic integrity?
Yes
No
1 points
QUESTION 35
1. While
preparing to perform an incision and drainage on a 7 cm fluctuant abscess on a
patients posterior thorax, the AGACNP knows that the most important part of the
procedure is:
A. Immediate
coverage with antistaphylococcal antibiotics
B. Maintaining
sterility with topical betadine and drapes
C. Breaking
up loculations and aggressive irrigation
D. Proper
injection of local anesthetic
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 36
1. A patient
is being evaluated with significant nausea, fatigue, and a general sense of feeling
unwell; mild jaundice is noted on physical examination. Transaminases are
markedly elevated and a hepatitis screening is done. Results are as follows:
+ HbsAb
+ anti-HAV IgM
– anti-HCV
The correct interpretation of these findings is:
A. The patient
has acute hepatitis A
B. The
patient has acute hepatitis B
C. The
patient has chronic hepatitis B
D. The
patient has acute hepatitis C
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 37
1. When
treating a patient with an unknown overdose or toxicity, the AGACNP knows that all
of the following should be administered except:
A. Dextrose
50%
B. Thiamine
100 mg
C. Nalaxone
0.4 mg
D. Ativan 4
mg
1 points
QUESTION 38
1. The
AGACNP is evaluating 29-year-old female who presents by ambulance and is
unresponsive. There is no witness and no history available; the patient is not
wearing any sort of medic alert bracelet. While assessing for toxicity or
overdose, the patient is found to have vital signs as follows: Temp of 96.2° F,
pulse of 48 b.p.m., respirations of 10 b.p.m., and blood pressure of 84/50 mm
Hg. The patient’s pupils are constricted, but do react briskly to light to 1
mm. The AGACNP suspects which type of substance?
A. Cholinesterase
inhibiting drugs
B. Stimulants
such as MDMA
C. Anticholinergics
D. Ethanol
or opiates
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 39
1. The
AGACNP knows that the one class of pain medication that is effective to some
extent for all forms of pain is:
A. NSAIDs
B. Antidepressants
C. Antiepileptics
D. Opiates
1 points
QUESTION 40
1. K.P. is a
76-year-old male admitted for antibiotic management of urosepsis. His medical
history is significant for a CVA with resultant right-sided hemiparesis. He is
nonverbal, maintained on enteral nutritional support and has an indwelling
Foley catheter. The AGACNP knows that which of the following bacteria is the
primary treatment target for this patient’s urosepsis?
A. Proteus
mirabilis
B. Pseudomonas
aeruginosa
C. Staphylococcus
aureus
D. Streptococcus
pneumoniae
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 41
1. A patient
is admitted for a COPD exacerbation and placed on mechanical ventilation. His
settings are as follows: FiO2 of 40%, TV of 700mL, SIMV of 12. His morning ABG
reveals a pH of 7.37, paCO2 of 51 mm Hg, paO2 of 84 mm Hg and HCO3 of 30 mm Hg.
The AGACNP knows that the appropriate response is to:
A. Leave the
ventilator settings as is
B. Increase
the SIMV to 16 b.p.m.
C. Increase
the FiO2 to 50%
D. Repeat
the ABG in one hour
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 42
1. All of
the following are required for a diagnosis of systemic inflammatory response
syndrome (SIRS) except:
A. White
blood cell count < 4000 or > 12,000 cells/uL
B. Heart
rate > 90 b.p.m.
C. Respiratory
rate > 20 b.p.m. or paCO2 < 32 mm Hg
D. Two sets
of positive blood cultures
1 points
QUESTION 43
1. J.T. is a
41-year-old female patient who presents with a chief complaint of “heartburn.”
She says that it doesn’t really seem to be related to meals or food—it occurs
at random times. She does note, when asked, that it seems to happen a lot at
night and occasionally wakes her up. Her only other symptom complaint is an
occasional cough. It does not produce mucus, and she admits to assuming it was
a “nervous” cough. The next appropriate action for the AGACNP would be to:
A. Order an
H. pylori test
B. Request a
GI consult for endoscopy
C. Order a
proton pump inhibitor 30 minutes before breakfast
D. Request a
72-hour diet history
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 44
1. Your
patient has diabetes insipidus (DI). Anticipated physical assessment findings include:
A. Dry skin,
tachycardia, hypertension
B. Weak
pulse, dry skin, decreased skin turgor
C. Thin
hair, thready pulse, dry mucous membranes
D. Hypothermia,
jugular venous distention, bradycardia
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 45
1. The
AGACNP is beginning medical management of a patient newly diagnosed with T2DM.
The patient has a BMI of 39 and has been unsuccessful in making significant
diet and lifestyle changes over the last six months. Other than her weight, her
physical examination is essentially within normal limits. Her HgbA1c is 9.5%. A
basic metabolic panel is within normal limits. The medication of choice to
begin therapy will be:
A. A
sulfonyurea
B. A
meglitinide
C. A
biguanide
D. An
incretin mimetic
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 46
1. Felty’s
syndrome is a condition of immune neutropenia seen sometimes in patients with:
A. Polymyalgia
rheumatica
B. Giant
cell arteritis
C. Systemic
lupus erythematosus
D. Rheumatoid
arthritis
1 points
QUESTION 47
1. When
treating a patient for the profound cough of acute bronchitis, the AGACNP knows
that the most appropriate pharmacotherapy consists of:
A. An opiate
based cough suppressant
B. Oral
prednisone
C. A first
generation-antihistamine combination
D. An
inhaled anticholinergic
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 48
1. Mr.
Truman is transferred to the emergency department by ambulance. His wife called
911 this morning because he was acting “funny” when he woke up. Both the
patient and his wife went to bed last night at approximately 10:30 and
everything was normal. This morning he could not communicate orally and seemed
confused about how to ambulate. Upon arrival to the emergency department his
vital signs are as follows: Temperature 100.9° F, pulse 89 b.p.m., respirations
14 b.p.m. and blood pressure 168/94 mm Hg. A non-contrast CT scan of the head
reveals thrombotic CVA. The AGACNP know that immediate management of this
patient should include:
A. Thrombolytics
B. IV
vasodilators
C. Aspirin
D. Antiepileptics
1 points
QUESTION 49
1. Your
patient is complaining of profound nausea and vomiting that started at bedtime
last night and kept him awake all night long. Early this morning he started
having abdominal cramping and explosive diarrhea. Based upon the character of
symptoms you are suspicious of infection with Staphylococcus aureus. To assess
risk for exposure to this organism, you ask the patient about which meal?
A. Breakfast
yesterday
B. Lunch
yesterday
C. Dinner
yesterday
D. Bedtime
snack yesterday
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 50
1. D.R. is a
54-year-old male patient who was admitted for the management of cellulitis and
treated with parenteral antibiotics. He has not been responding as well as
anticipated. During today’s exam the AGACNP appreciates a couple of changes.
All of the following indicate the need for immediate surgical evaluation
except:
A. Skin
anesthesia
B. Violaceous
bullae
C. Gas
bubbles in tissue
D. Lymphangetic
spread
1 points
QUESTION 51
1. R. O. is
a 21-year-old female who comes to the emergency department because of a severe
headache. Her vital signs and neurological examination are within normal
limits. She complains of a pulse-like pain in her right temple and admits that
she has almost vomited. Her mother gets the same type of headache and the last
time this happened R.O. took one of her mother’s prescription headache pills.
They helped a lot, but this time her mother told her she had to come be
evaluated. The AGACNP knows that which of the following is the appropriate
action?
A. A
non-contrast CT scan of the head
B. Administration
of a 5HT agonist
C. Dilaudid
2 mg IM x 1 dose
D. Requesting
a headache diary
1 points
QUESTION 52
1. A
39-year-old female presents for evaluation of a rash. She denies any
significant medical history, and has no other complaints. The rash appeared
suddenly on both forearms approximately one week ago, and she is concerned
because it is not going away. It does not itch or hurt—it is just there. Physical
examination reveals a diffuse macular hypopigmentation on both forearms that
extends to the hands. The patient denies any drug or alcohol use; she is single
and has had 4 unprotected sexual partners in the last year. The AGACNP knows
that initial laboratory testing must include a(n):
A. FTA-Abs
B. Fungal
skin scraping
C. RPR
screening
D. CBC
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 53
1. J.S. is a
African-American female who presents for a wellness examination. Her medical
history is significant for beta thalassemia minor. Anticipated red blood cell
differential would include which of the following patterns?
A. Hgb 10.2
g/dL, Hct 30%, MCV 70 fL, RDW 12.6%
B. Hgb 9.9
g/dL, Hct 28%, MCV 83 fL, RDW 13.9%
C. Hgb 11.5
g/dL, Hct 35%, MCV 94 fL, RDW 15.8%
D. Hgb 12.8
g/dL, Hct 38%, MCV 105 fL, RDW 18.1%
1 points
QUESTION 54
1. M.T.
presents complaining of acute pain in his left eye, nausea, and one episode of
vomiting. He denies any significant medical problems, and says that the only
medication that he takes is an occasional over-the-counter sleeping pill.
Physical examination reveals a steamy red cornea and conjunctiva with a pupil that
is 5 mm and not reactive to light. The AGACNP knows that diagnostic testing
should include:
A. A CT scan
of the head
B. An MRI of
the orbit
C. A
toxicology screen
D. A
measurement of intraocular pressure
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 55
1. Justin is
a 23-year-old male who is being managed for an acute manic episode. Justin was
diagnosed with bipolar disorder several years ago, but his home life has been
unstable and he has not been very adherent to a medication regimen. Most
recently he was started on the SNRI venlafaxine by his primary care provider,
which he has been taking as prescribed for about 6 weeks, but he began a manic
episode a few days ago which peaked this evening. The AGACNP considers that:
A. The manic
episode is probably a result of medication instability and he should continue
his current regimen with a follow-up in 6-8 weeks
B. A mood
stabilizing agent should be added to the venlafaxine
C. All
medication should be held for 6-8 weeks and the then the patient should be
reevaluated
D. The SNRI
should be stopped and a mood stabilizing agent started
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 56
1. Mr.
Livingston is a 79-year-old male who presents from a long term care facility
with a change in mental status. His medical history is significant for T2DM,
CAD, CHF, hypothyroidism, Alzheimer’s dementia and osteoarthritis. He has been
stable, but over the last few days the staff say he has been a bit
disconnected. This morning he was found in his bed in a stuporous state. His
vital signs include a temperture of 98.9° F, pulse of 103 b.p.m., respiratory
rate of 20 b.p.m., and a blood pressure of 92/64 mm Hg. His metabolic panel
demonstrates a Na+ of 129 mEq/L, K+ of 3.3 mEq/L, Cl- of 100 mEq/L, CO2 of 24
mEq/L, glucose of 644 mg/dL, BUN of 51 mg/dL and creatinine of 1.9 mg/dL. The
AGACNP knows that the primary problem is most likely:
A. Diabetic
ketoacidosis
B. Hypertonic
hyponatremia
C. Myxedema
coma
D. Hyperosmolar
hyperglycemic coma
1 points
NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 57
1. The
AGACNP is evaluating a patient with systemic lupus erythematosis who complains
of fatigue. Based upon his knowledge of the most commonly affected visceral
organ, which of the following diagnostic studies should be ordered?
A. Echocardiogram
B. Chest
radiography
C. Hepatic
function enzymes
D. Urinalysis
with microscopic
1 points
QUESTION 58
1. All of
the following are true statements about post-traumatic stress disorders (PTSD)
except:
A. It is
more common in women than men
B. It is
unlikely to occur in children especially < 10 years old
C. It is
differentiated from acute stress reaction by time
D. It is not
likely in persons with no preexisting psychiatric disease
1 points
QUESTION 59
1. Ray M., a
49-year-old male, walks into the emergency room complaining of back pain. He
has never had this problem before and cannot identify any injury, but he is in
such severe pain he is sure something is wrong. He states that his back has
been hurting so badly sometimes he has to stop whatever he is doing and bend
forward at the waist. The pain also travels along the outer edge of his left
thigh to mid-calf, and he reports a small area of numbness on his anterior
thigh. His history and physical examination are otherwise negative. He is an
insurance attorney and is not especially active at work, but goes to the gym 5
days a week. He is not overweight, and his vital signs are normal. Physical
examination reveals no paraspinal tenderness, and his straight leg raise is
negative. A few times during the exam he lay back on the table and grabbed his
left leg, flexed both hip, and pulled his knee to his chest, because it helped
the pain. The AGACNP knows that immediate pain relief measures must include:
A. An opiate
analgesic
B. Systemic
steroids
C. Physical
therapy
D. Bedrest
for 72 hours
1 points
QUESTION 60
1. A patient
with peptic ulcer disease is admitted to the hospital with significant upper
abdominal discomfort. She has guarding and rebound tenderness on examination.
Abdominal radiography demonstrates free air in the abdomen. The AGACNP knows
that the immediate priority is to:
A. Obtain a
stat surgical consult
B. Begin an
IV proton pump inhibitor
C. Order an
abdominal CT scan
D. Obtain a
stat gastroenterology consult
1 points
QUESTION 61
1. Jennifer
is a 15-year-old female who attempted suicide by taking a bottle of
acetaminophen. She took 30, 500 mg tablets approximately six hours ago, but
then became frightened and told her mother what she did. Her mother said that
Jennifer seems OK, other than being a little sick to her stomach, she has no
complaints. The AGACNP knows that the first step in her care includes:
A. N-acetycysteine
in tapering doses over the next 24 hours
B. Oral
administration of activated charcoal
C. Psychiatric
assessment
D. Discharge
to home with follow-up LFTs in 4 days
1 points
QUESTION 62
1. Mrs.
Glassman is a 55-year-old female who presents with a chief complaint of fever.
Her vital signs reveal a temperature of 100.0° F, blood pressure of 100/60 mm
Hg, pulse of 114 b.p.m. and respirations of 20 b.p.m. Her cardiac auscultation
reveals a grade III/VI systolic murmur at the left lower sternal border. Her
history is significant for an eyebrow lift 4 months ago. The AGACNP orders
which test to confirm the suspected diagnosis?
A. Three
sets of blood cultures
B. A chest
radiograph
C. A 12-lead
ECG
D. Induced
sputum culture
1 points
QUESTION 63
1. John is a
17-year-old male who is in the emergency department with abdominal pain. He is
quite uncomfortable and says that it started yesterday and seemed to be “in the
middle of his stomach” but today it has moved over to the right lower side.
During physical examination the abdomen is not distended, but he is guarded,
and right lower quadrant palpation produces significant discomfort, especially
upon release of the palpating hand. He has appreciable pain when his right knee
and hip are bent to a 90° angle. John admits to some nausea but has not
vomited; he has not had a normal bowel movement in two days. His vital signs
are as follows: Temperature 100.9° F, pulse 110 b.p.m. respiratory rate 22
b.p.m., and blood pressure 118/77 mm Hg. The AGACNP orders which of the
following tests to confirm the suspected diagnosis?
A. Complete
blood count
B. Ultrasound
C. CT scan
D. Urinalysis
1 points
QUESTION 64
1. Which of
the following signs is expected in patients with cholecystitis?
A. McBurney’s
B. Cullen’s
C. Spurling’s
D. Murphy’s
1 points
QUESTION 65
1. According
to the World Health Organization’s step-wise approach to pain management,
initial approaches to step 2 might include all of the following except:
A. A weak
opiate
B. A strong
opiate
C. A
non-steroidal antiinflammatory agent
D. An antidepressant.
1 points
QUESTION 66
1. A
patient’s Weber test lateralizes to the right ear and the Rinne test in both
ears is normal. The patient has a:
A. Sensorineural
hearing loss in the left ear
B. Sensorineural
hearing loss in the right ear
C. Conductive
hearing loss in the left ear
D. Conductive
hearing loss in the right ear
1 points
QUESTION 67
1. J.B. is a
62-year-old male who was admitted three days ago for management of
diverticulitis. Today the AGACNP is called to the bedside to evaluate new onset
swelling of the right lower extremity. According to the staff nurse it was not
present yesterday but on today’s assessment the patient had 2A+ edema up to the
thigh. Initial diagnostic evaluation should include:
A. Homan’s
sign
B. A venogram
C. A D-dimer
D. CT of the
chest
1 points
QUESTION 77
1. A
30-year-old male patient presents for evaluation of a lump on his neck. He
denies pain, itch, erythema, edema, or any other symptoms. He is concerned
because it won’t go away. He says, “I noticed it a few months ago, then it
seemed to disappear, and now it is back.” The AGACNP proceeds with a history
and physical exam and concludes which of the following as the leading
differential diagnosis?
A. Subclinical
infection
B. Non-Hodgkin’s
lymphoma
C. Catscratch
disease
D. Syphilis
1 points
QUESTION 78
1. Ms.
Teller presents with a chief complaint of weight loss. She reports an unplanned
10 lb weight loss over the last 5-6 months. She has no significant medical
history, but review of systems reveals bilateral shoulder discomfort and some
impaired range of motion—she has trouble pulling clothing over her head. Over
the last few months she has generalized upper body stiffness, but seems to get
better after an hour or so of activity. When considering a diagnosis of
polymyalgia rheumatica, laboratory assessment may be expected to reveal:
A. An
erythrocyte sedimentation rate (ESR) of 75 mm/hr
B. A
microcytic, hypochromic anemia
C. Elevated
liver function enzymes
D. Positive
antinuclear antibodies
1 points
QUESTION 79
1. When a
patient has lower abdominal discomfort, cervical wall motion tenderness, and
adnexal tenderness, the AGACNP knows that this will likely be treated with:
A. Ceftriaxone
and azithromycin
B. Metronidazole
and ciprofloxacin
C. Trimethoprim/sulfamethoxazole
D. IV fluid
and pain control
1 points
QUESTION 80
1. J.L. is
an 81-year-old female who is admitted from home after her daughter found her
confused and unkempt. She is not a good historian, and her daughter cannot
provide any information—when she saw her mother a week ago, she was fine.
J.L.’s vital signs are as follows: Temperature 101.4° F, pulse 99 b.p.m.,
respirations 22 b.p.m., and blood pressure 90/58 mm Hg. Her urinalysis is shows
+++ leukocytes, + RBC, and + nitrites. Her metabolic panel reveals a BUN of 39
mg/dL and creatinine of 1.5 mg/dL. The AGACNP knows that J.L has findings
consistent with:
A. Pre-renal
failure
B. Intra-renal
failure
C. Post-renal
failure
D. Chronic
renal failure
1 points
QUESTION 81
1. Patients
with giant cell arteritis are at increased risk of:
A. Cerebrovascular
accident
B. Rheumatoid
arthritis
C. Polymyalgia
rheumatica
D. Osteoarthritis
1 points
QUESTION 82
1. The
AGACNP is called to the bedside for a patient who is in cardiopulmonary arrest.
The monitor demonstrates ventricular fibrillation which will not convert
despite several attempts to defibrillate at maximal voltage. While being
briefed by the staff nurse on the patient medical history, he learns that the
patient has a history of Cushing’s syndrome. The AGACNP recognizes that the
patient is probably failing to convert due to:
A. Advanced
atherosclerotic disease
B. Hypokalemia
C. Hypocalcemia
D. Catecholamine
excess
1 points
QUESTION 83
1. When
performing an evaluation of a patient following seizure activity, the AGACNP
knows that the most important component of that evaluation is:
A. A CT scan
of the head
B. Eyewitness
description
C. An EEG
D. Administering
a benzodiazepine
1 points
QUESTION 84
1. Which of
the following etiologic organisms is most likely to appear as lobar
consolidation on chest radiography?
A. Legionella
pneumophilia
B. Streptococcus
pneumoniae
C. Pneumocystis
carinii
D. Mycoplasma
pneumoniae
1 points
QUESTION 85
1. A patient
with chronic kidney disease presents with an eGFR of 30 mL/min/1.73m2. The
AGACNP knows that the most compelling implication of this value is:
A. Control
of risk factors for renal deterioration
B. Careful
attention to renal dosing of medications
C. Referring
the patient for shunt placement
D. Preventing
occurrence of renal ischemia
1 points
QUESTION 86
1. Differential
diagnosis of hematuria include all of the following except:
A. Bladder
cancer
B. Nephrolithiasis
in the renal parenchyma
C. Urinary
tract infection
D. Prerenal
azotemia
1 points
QUESTION 87
1. A
29-year-old male patient presents with acute scrotal pain and dysuria. He has a
temperature of 101.8° F and a pulse of 115 b.p.m. but otherwise vital signs are
within normal limits. He gets some relief of the scrotal discomfort when his
scrotum is elevated on a rolled towel. This is known as:
A. Varicocele
B. Prehn’s
sign
C. Cremasteric
sign
D. Testicular
torsion
1 points
QUESTION 88
1. The
AGACNP knows that patients with psoriasis are at greater risk for:
A. Arthritis
B. Eczema
C. Cellulitis
D. Melanoma
1 points
QUESTION 89
1. Mr.
McCarran is a 68-year-old male with a long history of poorly controlled T2DM.
He has had progressive burning pain in both feet for the last year or so, but
in the last few months it has become increasingly worse. He has tried taking
ibuprofen and naproxyn over-the-counter with no improvement. Now, he is
presenting for more effective pain management. The AGACNP knows that the
medication of choice will be from which drug class?
A. NSAIDs
B. Opiates
C. Antiepileptics
D. Anesthetics
1 points
QUESTION 90
1. Mr.
Starwood is a 61-year-old male who was admitted last night for the management
of acute pancreatitis. He was admitted n.p.o and started on intravenous fluid
and opiate pain management. This morning he reports feeling significantly
better. His C-reactive protein this a.m. is 5 mg/dL, amylase and lipase are
both just over 2 x upper limits of normal, and his Ransom score is 2. The
AGACNP knows that the next step in his care is to:
A. Begin
clear liquids as tolerated
B. Order an
abdominal CT
C. Order an
ERCP
D. Continue
the current management for 24 hours
1 points
QUESTION 91
1. When
beginning pharmacotherapy for depression, the AGACNP discusses with the patient
that a primary safety consideration includes the:
A. Increased
risk of suicide when patients begin antidepressant therapy
B. Potential
for sexual adverse effects
C. Better
likelihood of success when medications and therapy are used together
D. High
incidence of serotonin syndrome
1 points
QUESTION 92
1. When
ruling out meningitis in a patient, the AGACP appreciates that the spinal fluid
is cloudy and the glucose content is 20 cells/microliter. This is most
consistent with:
A. Aseptic
meningitis
B. Septic
meningitis
C. Chemical
meningitis
D. Chronic
meningitis
1 points
QUESTION 93
1. A
44-year-old male patient presents in a hypertensive crisis. The blood pressure
is 240/136 mm Hg, pulse is 128 b.p.m. and the patient is complaining of a
severe, pounding headache. His skin is diaphoretic and he is visibly tremulous.
The first diagnostic study to evaluate the suspected diagnosis should be a:
A. 24 hour
urine for catecholamine metabolites
B. Serum
epinephrine and metanephrines
C. T scan of
the abdomen
D. MRI of
the abdomen
1 points
QUESTION 94
1. An
unidentified patient is brought to the emergency department by ambulance after
being hit by a motor vehicle. She has multiple injuries and an estimated blood
loss of 2 liters. The hematocrit is 19%. The AGACNP expects that the mean cell
volume (MCV) would most likely be:
A. 70 fL
B. 80 fL
C. 90 fL
D. 110 fL
1 points
QUESTION 95
1. Mrs.
Oliver is a 71-year-old petite Caucasian female. During a routine dexa
screening she was found to have a T-score of -3.0. The AGACNP knows that the
first intervention should include:
A. Calcium
B. Vitamin D
C. Bisphosphonates
D. Estrogen
1 points
QUESTION 96
1. When
evaluating a family with suspected carbon monoxide exposure, the AGACNP knows
that assessment should include all of the following except:
A. Vital
signs
B. Pulse
oximetry
C. Cardiac
rhythm strip
D. Carboxyhemoglobin
level
1 points
QUESTION 97
1. Mr. Riley
is a 61-year-old male who just had bilateral knee replacements. There was more
fluid loss than intended during the procedure. The AGACNP knows that metabolic
alkalosis is the most common postoperative acid-base imbalance and is best
treated with:
A. Normal
saline infusion
B. An
insulin drip
C. Low
volume hydrochloric acid
D. Albumin
1 points
QUESTION 98
1. Patients
in advanced stages of chronic kidney disease are at greatest risk for which of
the following conditions?
A. Polycythemia
B. Hypokalemia
C. Metabolic
alkalosis
D. Anemia
1 points
QUESTION 99
1. The
diagnostic study of choice in mesenteric ischemia is:
A. Ultrasound
B. CT
angiography
C. MR
angiography
D. Diagnostic
peritoneal lavage
1 points
QUESTION 100
1. Mr.
Maxwell is a 58-year-old male who presents with left foot pain. Physical
examination reveals a foot that is normal in appearance with DP and PT pulses
that are barely audible by Doppler. The AGACNP has the patient cross the leg
with the left foot resting on the right knee; after 30 seconds that left foot
is briskly lowered to the floor. Instantly the left foot turns bright red. This
is known as:
A. Venous
insufficiency
B. Brawny
hyperpigmentation
C. Homan’s
sign
D. Dependent
rubor
1 points
QUESTION 101
1. 152: When
completing this exam, did you comply with Walden University’s Code of Conduct
including the expectations for academic integrity?
Yes
No

Walden_NURS6640_Final_Exam_July_2019.docx (66.74 KB)

Review Test Submission Week 11 Final Exam: Walden NURS6640 Final Exam Course NURS-6640 Psychotherapy Individual
Course NURS-6640 Psychotherapy Individual
• Question
1 A PMHNP is using Gestalt therapy to communicate with a 50-year-old patient who is going through a divorce.
As he is calmly sharing the details of his divorce, the PMHNP notices that Dave
is tapping his fingers on his legs. What is an appropriate response by the
PMHNP using the technique of focusing?
• Question
2
A
25-year-old female states, “I really need to lose weight. I know I’m the cause
of our problems, if I could just lose
weight he might be more attracted to me. Then we could start a family and we
would be happy. I’m sure of it, right, we would definitely be happy!” Which
statement shows the PMHNP’s ability to apply “summarizing”?
• Question
3
As part
of the PMHNP’s role in the clinic, the PMHNP oversees students that gain
clinical experience at the agency. The student is instructed to use the
supportive psychodynamic therapy approach with the patient. Which action made
by the student causes the PMHNP to intervene, after observing the student interacting
with the patient?
• Question
4
A PMHNP
is using motivational interviewing (MI) with a 50-year-old patient named Dave
to commit to a healthy drug-free lifestyle. By using “change talk,” the PMHNP
hopes to help the patient build self-esteem and hope.
True or false: If Dave is resisting change, the PMHNP should
challenge his resistance in order for MI to be successful.
• Question
5 The PMHNP is actively listening
to Ms. Thomas who is detoxing from alcohol. Ms. Thomas is currently discussing
with the PMHNP the reasons why she feels guilty about her drinking. Ms. Thomas
tearfully states, “I have driven my family and friends away with this terrible
habit. I have no one left. I had more than enough chances and now my children
won’t even talk to me.” Which of the following statements demonstrate a simple
reflection?
• Question
6 A PMHNP is using Gestalt
therapy to communicate with a 42-year-old patient who is upset with her mother.
She says, “I want to tell her how hurt I feel when she doesn’t call me, but I
don’t want to upset her.” What technique can the PMHNP use to help Sasha
express herself?
• Question
7 The PMHNP is meeting with an
older, female adult patient and her daughter. The patient has early onset
dementia. The daughter expresses concern, saying, “I don’t want you to just
stick my mother in a home and give her medicine. I’m worried that’s what people
are going to want to do.” What is the best response by the PMHNP to the
daughter?
• Question
8 The PMHNP meets with a
31-year-old woman who reports feeling as though she is “at her breaking point”
with work. The PMHNP learns that the woman works 12-hour days, including one
day on the weekend, because she is nervous about company layoffs. “I feel like
I need to work myself to death in order to prove that I am valuable to the
organization,” the woman says. Using the supportive psychodynamic therapy
approach, how does the PMHNP respond?
• Question
9 When preparing to terminate a
patient, what does the PMHNP do to organize thoughts about the patient’s progress
made during treatment?
• Question
10 Linda is a 65-year-old patient
who has completed initial treatment for alcohol addiction and anxiety problems.
She is motivated to continue her treatment gains and have a healthy lifestyle.
How would the PMHNP apply a mindfulness approach to this case?
• Question
11 The PMHNP is caring for a young
adult patient with whom the PMHNP decides to use a dynamic supportive therapy
approach in addition to pharmacological intervention. Which therapeutic action
will the PMHNP take to employ the strategy of holding and containing the
patient?
• Question
12 The PMHNP is caring for an adult
male patient whose wife left him several months ago. He recently learned that
his ex-wife is dating someone much younger. The man feels belittled, sad, and
lonely. He talks about trying to meet other women, but says, “I can’t compete
with the younger guys these days, with the cool clothes and the vegan diets.
I’m bald and overweight, and what woman is going to want to be with me?” How
does the PMHNP help raise the man’s self-esteem?
• Question
13 A 43-year-old single mother is
seeing the PMHNP at the request of her sister. “My sister thinks I need to come
here to talk about my feelings,” the patient reports. The PMHNP learns that the
patient has three children from three different men, but is unable to collect
appropriate child support payments from any of the biological fathers.
Additionally, the woman is barely able to afford her apartment or utilities
payments. What is the appropriate response from the PMHNP when using the
psychodynamic psychotherapy technique?
• Question
14 The PMHNP has been providing
interpersonal psychotherapy (IPT) for a patient who the PMHNP observes
implementing new ways of being, such as interacting more with peers and being
less isolated in social scenarios. The PMHNP understands that the patient is
approaching termination. How does the PMHNP address termination with this
patient?
• Question
15 A PMHNP has been treating a
14-year-old patient using interpersonal psychotherapy. The patient has been
depressed since the death of his grandmother. To help the patient recover, the
PMHNP has told the parents:
• Question
16 In the planning phase of change,
a 42-year-old male client who struggles with gambling discusses how he plans to
abstain from gambling. He tells the PMHNP, “I am no longer going to carry cash
to the casino because you can’t spend what you don’t have.” The PMHNP uses an
affirming communication skill when she states:
• Question
17 The PMHNP is assessing a patient
who has been receiving months of outpatient psychotherapy. According to the
PMHNP’s assessment, the patient is nearing the termination phase of their
therapeutic relationship because the patient’s symptoms have improved, and the
patient shows progress managing behaviors and decision-making abilities
according to the diagnosis. How does the PMHNP approach termination with this
patient?
• Question
18 The PMHNP is caring for a
patient who is histrionic. Using the supportive psychodynamic therapy model,
what is the best statement made by the PMHNP?
• Question
19 A cocaine-addicted female
patient is entering residential treatment for substance abuse. Using the 10
guiding principles of recovery, an appropriate step by the PMHNP is to
______________.
• Question
20 A PMHNP is assessing a
40-year-old patient named Sarah who has a severe cocaine addiction and mild
depression. Using the four-quadrant model, what would be the most appropriate setting
to help the patient?
• Question
21 A 21-year-old patient has been
having trouble adjusting to college life. She tells the PMHNP that she had five
alcoholic drinks at a party this past weekend. She also acknowledges that she
drank the same amount of alcohol at a party the previous month. Based on this
information, what would the PMHNP most likely recommend?
• Question
22 A PMHNP is using emotion-focused
therapy to help a 38-year-old patient who says, “I’ve been feeling angry
lately, but I’m not sure why.” The first attempt by the PMHNP is to say:
• Question
23 The PMHNP uses the Adult
Attachment Interview (AAI) with a male patient who reports having had a
difficult time being separated from his parents during his childhood. He
explains that going to school or visiting his relatives without his parents was
troublesome. The PMHNP characterizes the patient as unresolved/disorganized,
according to his outcomes on the AAI. What does the PMHNP anticipate from the
patient?
• Question
24 The PMHNP is interviewing a
patient who is in the process of successfully completing a substance abuse
program. During the interview, the patient states, “I wish I was strong enough
to keep the same friends I had before I came here for treatment. I’m really
afraid of being discharged because I’ll probably run into my old friends
again.” The PMHNP offers a complex reflection when she states the following:
• Question
25 A PMHNP is using interpersonal
psychotherapy with a 40-year-old patient having relationship problems with his
extended family. The patient shares that he has been using the strategies they
identified to reduce his distress, but they have not been helping. He is
frustrated and is considering stopping treatment. What would be an appropriate
step by the PMHNP?
• Question
26 An 8-year-old has been having
trouble making friends at school. His parents initiated treatment when he also
started acting out at home. Which is the most appropriate step that the PMHNP
takes during the assessment process when using an integrated approach?
• Question
27 The PMHNP is treating an older
adult patient who reports symptoms of late-life anxiety. What type of treatment(s)
will the PMHNP consider?
• Question
28 The PMHNP is assessing a patient
who requires cognitive behavioral therapy (CBT). Which of the following
statements made by the PMHNP approach the termination phase for this patient?
• Question
29 A patient’s depression is
affecting her relationship with her spouse. What might the PMHNP ask during the
initial sessions of interpersonal psychotherapy treatment?
• Question
30 A PMHNP is treating a
10-year-old boy who is exhibiting signs of aggression and attention problems.
What type of intervention will the PMHNP consider using a common elements
approach?
• Question
31 The PMHNP who practices
motivational interviewing understands its relationship to patient behaviors
and/or outcomes to mean which of the following?
• Question
32 A PMHNP is treating a
12-year-old girl who witnessed the physical abuse of her sibling. She has been
anxious and irritable since the experience. After speaking with the PMHNP, the
patient says she keeps having anxiety-causing thoughts about the experience.
Using the PRACTICE technique, which skill will best help the patient interrupt
these negative thoughts?
• Question
33 The PMHNP is working with a
patient who describes having a painful and traumatic childhood experience,
which causes her to have anxiety as an adult. When asked how she manages her
anxiety, the patient dismisses it and denies that it is a problem. Using the
supportive psychotherapy approach, the PMHNP will do which of the following
when assessing the patient’s ego strength?
• Question
34 The PMHNP uses therapeutic
communication skills while ensuring that the patient understands that he has
choices. The PMHNP comprehends and practices motivational interviewing. This is
best understood as which of the following?
• Question
35 While assessing a patient using
a humanistic-existential approach, a patient tells the PMHNP, “For the past few
weeks, I’ve felt anxious almost every single day.” What would be an appropriate
next step by the PMHNP?
• Question
36 The PMHNP is meeting with a
patient who has been diagnosed with depression. The patient is having trouble
adjusting to her new job and hasn’t made any new friends there. What would an
appropriate response be by the PMHNP using the interpersonal psychotherapy approach?
• Question
37 A 38-year-old patient tells the
PMHNP that her father went to jail for selling drugs when she was a child. The
patient is visibly upset when discussing what happened. Using a
humanistic-existential approach to psychotherapy, which of the following is the
most appropriate response by the PMHNP?
• Question
38 The PMHNP is assessing an older
adult male patient with depression and comorbidities. According to the medical
chart, the patient takes medication to manage joint and bone pain. The patient
reports feeling “forgetful” and complains that he has a hard time remembering
where he puts things. What is the primary action by the PMHNP?
• Question
39 A 35-year-old male patient is
being treated for alcohol addiction. He asks for the PMHNP’s cell phone number
to use in case of an emergency. When the PMHNP responds that giving her number
would be against therapeutic rules, the patient threatens an act of violence to
the therapist. What would be the most appropriate response by the PMHNP?
• Question
40 The PMHNP is caring for a
geriatric patient who expresses symptoms of gastrointestinal problems, aches
and pains, and loss of appetite. The patient reports feeling lonely, as more of
his friends have been passing away over the recent months and years. The PMHNP
focuses on which therapeutic approach for this patient?
• Question
41 A 12-year-old girl was referred
for treatment after witnessing the physical abuse of her sibling by their
mother. The patient has been anxious and irritable since the experience. What
evidence-based treatment would be most appropriate for the PMHNP to use?
• Question
42 The PMHNP uses the cognitive
behavioral therapy model with Gerald, an older adult patient who is being
treated for depression and mood disorder. What will the PMHNP do with the
patient during the first three sessions?
• Question
43 The PMHNP is initiating a plan
of care for a patient who requires comprehensive psychotherapy to manage his
depression and mood disorder. Throughout the initial sessions, the patient
reports feeling as though he cannot be helped. The PMHNP is concerned about
premature termination initiated by the patient. What strategy can the PMHNP
employ to prevent or reduce premature termination?
• Question
44 How does the PMHNP approach
termination with the patient who has been receiving intermittent therapy?
• Question
45 A PMHNP is treating a
25-year-old patient who has a compulsive urge to exercise to excess. When asked
to describe why she does so much exercise, she says, “I like the compliments I
receive from others on my new level of fitness, and the excitement of getting
more attention.” The PMHNP can use feeling-state therapy to help Monique
___________.
• Question
46 A 19-year-old female patient
named Anna, who was the victim of child abuse and neglect, is also in treatment
for substance abuse. At her most recent appointment, Anna confesses to the
PMHNP that she is having romantic fantasies about him, and explains the he is
one of the few people she trusts. She believes that he is interested in her as
well. What is the most appropriate response by the PMHNP in this situation?
• Question
47 A 21-year-old patient is worried
about starting a new job. She talks about her fears of failure and not making
friends at the office. Using a person-centered approach, an appropriate
response by the PMHNP is to ______________.
• Question
48 The PMHNP initiates
feeling-state therapy to help a 25-year-old patient named Monique who has a
compulsive urge to exercise. Using the Feeling-State Addiction Protocol, what
is an appropriate next step the PMHNP should take after identifying the
specific positive feeling linked with the addictive behavior and its Positive
Feeling Score level?
• Question
49 The PMHNP is caring for an older
adult patient who presents with mixed dysphoric states and whose daughter
reports “is becoming more irritable more easily.” When talking with the
patient, the PMHNP also recognizes displays of cognitive dysfunction. Which
treatment options will the PMHNP most likely suggest?
• Question
50 Following an attempted suicide,
Mr. Durham was admitted to an acute psychiatric facility. After 4 weeks in
treatment, he is preparing for discharge. He is beginning to miss individual
and group therapy sessions and has refused medications twice in the past 2
days. The PMHNP demonstrates understanding in this phase by saying which of the
following statements?
• Question
51 The PMHNP assesses a 27-year-old
patient named Jeff, who was a victim of child abuse and neglect. Jeff says that
he remembers a traumatic situation that he wants to share, but is having
trouble talking about it. Which statement made by the PMHNP demonstrates the
use of emotion-focused therapy?
• Question
52 The PMHNP has been providing
supportive psychodynamic psychotherapy to a patient and is nearing the
termination stage. The PMHNP will use which criteria for determining that the
patient is ready for termination?
• Question
53 The PMHNP has been treating a
patient who is now being transferred to another provider. What is the appropriate
action made by the PMHNP?
• Question
54 A PMHNP has been treating a
9-year-old patient who was referred by her school. Students are asked to raise
their hands before speaking during group discussion, but the patient seems to
blurt out what she wants to say without being called on. She also interrupts
other children while they are talking instead of waiting her turn. When the
patient gets frustrated, she has trouble controlling her emotions and cries
often. Based on the initial information provided, the first focus by PMHNP is
the child’s ____________.
• Question
55 When completing this exam, did
you comply with Walden University’s Code of Conduct including the expectations
for academic integrity?
• Question
56 A 38-year-old patient has been
having trouble communicating with his teenage daughter. Using a
solution-focused therapy approach, the PMHNP responds by saying, “When was a
time that a communication problem could have occurred, but did not?” In this
case, what type of question is the PMHNP asking?
• Question
57 A patient is finishing the
active treatment phase of interpersonal psychotherapy (IPT). After the PMHNP
reminds the patient that she has three sessions left, the patient says nothing,
but looks distressed. What would be the best reply by the PMHNP following IPT
protocol?
• Question
58 The PMHNP is in the process of
terminating treatment with a patient who witnessed the death of her parent who
used to sexually abuse her. What does the PMHNP understand about terminating
this patient?
• Question
59 The PMHNP is caring for an older
patient with major depressive disorder, seasonal pattern. The patient has been
resolute about not taking medication to manage the depression brought on by his
illness, stating that it is against his yogic lifestyle. In addition to
psychotherapy, what can the PMHNP suggest to this patient?
• Question
60 The PMHNP is caring for an older
adult patient who is in the acute phase of schizophrenia. Which therapeutic
model will the PMHNP employ with this patient?
• Question
61 A PMHNP is assessing a
60-year-old patient named Carlos. He has severe PTSD and mild substance abuse
issues. The most appropriate setting to treat Carlos would be a _________.
• Question
62 The PMHNP is terminating
treatment for a patient who has been receiving eye movement desensitization and
reprocessing (EMDR) therapy. What action does the PMHNP take at the final
session to terminate treatment?
• Question
63 The PMHNP is treating an older
adult patient who reports experiencing nightmares associated with an automobile
accident he was in 20 years ago. As the PMHNP formulates the case using the
dynamic supportive therapy model, what questions will the PMHNP use during the
session?
• Question
64 The PMHNP is assessing a new
geriatric patient who reports symptoms of depression. The PMHNP wants to
identify the patient’s symptom severity over time. Which assessment tool will
the PMHNP use to collect this data on the patient?
• Question
65
When
recalling the phases of change, the PMHNP demonstrates “open questioning” in
the “engagement” phase by making which statement?
• Question
66
A 55-year-old
patient recovering from substance abuse tells the PMHNP, “It’s impossible to
meet new people. I really hate being single.” Using existential psychotherapy,
what might the PMHNP say next?
• Question
67
The
PMHNP is communicating with a middle-aged male patient who has a history of
addiction to Percocet (acetaminophen/oxycodone). The patient suddenly yells, “I
do not have a problem with pain pills! I’ve never had an overdose and no one
even knows that I take them unless I tell them.” The PMHNP understands that
there are phases of change and can best demonstrate “focusing” by responding
with:
• Question
68
The
PMHNP is terminating treatment with a patient who is aggressive and has a
history of anger. What does the PMHNP do when terminating treatment with this
patient?
• Question
69
The
PMHNP is assessing a 30-year-old client who reports feeling stressed out due to
his current employment situation. When asked about how he manages this
work-related stress, the patient says that exercise helps him feel less
anxious, so he often spends 2 or more hours at the gym each night. After
completing the patient assessment, the PMHNP has determined that an existential
psychotherapy approach may best benefit this client. What is the PMHNP’s goal
in employing this treatment approach?
• Question
70
The
PMHNP is interviewing a patient with a history of substance abuse. He has
attempted to stop abusing drugs three times before. He states to the PMHNP, “I
just cannot change. How can you help me?!” As it applies to change, the PMHNP
understands the principle of evocation to mean:
• Question
71
A PMHNP
has been working with a 50-year-old patient who has a stressful job and goes to
the casino on weekends to play poker with his friends, which he says relieves
his stress. Tim admits that he sometimes misses work on Monday when he stays
out too late at the casino on Sunday nights. In addition, he once was an avid
runner, and has given up running to spend more time gambling.
True or false: According to the PMHNP, the desired goal
after treatment is not complete abstinence from gambling, but reaching a healthy
level of the behavior.
• Question
72
The
PMHNP is caring for a patient who experiences depression caused by the
traumatic experience of her dog passing away. She reports not being able to eat
or sleep, and sometimes doesn’t want to leave the house at all. Which statement
is most appropriate for the PMHNP to maximize the patient’s adaptive coping
mechanisms?
• Question
73
A
13-year-old patient and his parents are meeting with a PMHNP. When the PMHNP
says hello, the boy just nods. His parents tell the PMHNP that he didn’t want
to come to the session, but they insisted. They explain that their son has been
moody and depressed at home, but is still getting good grades at school. Which
of the following would be the best response by the PMHNP?
• Question
74
The
PMHNP is initiating a plan of care for Holly, a 73-year-old female patient who
has late-life bipolar disorder and reports consuming alcoholic beverages four
times per week. What is the focus of Holly’s therapy going to be?
• Question
75
The
PMHNP continues to meet with Gerald, who is the patient with depression and
mood disorder. The PMHNP uses the CBT approach. Gerald is now meeting with the
PMHNP for his fifth session and feels comfortable with how the therapy works.
What does the PMHNP plan to do with Gerald over the course of the next several
sessions?
• Question
76
Mia is
a 75-year-old patient who has completed initial treatment for depression. What
might a PMHNP ask Mia when using a solution-focused therapy approach?