Personality Disorders and Substance Use Disorder: Case Studies and Treatment, Exams of Nursing

Download Personality Disorders and Substance Use Disorder: Case Studies and Treatment and more Exams Nursing in PDF only on Docsity! NURS 6670 MID-TERM EXAM-QUESTIONS AND ANSWERS (VERIFIED). Latest 2024. Question 1 Alexa is a 27-year-old female who has come to group therapy while she is in the city jail. She was arrested for vagrancy because she was sleeping in her car in a parking lot at a local shopping center. She could not post bail, so she is sentenced to 14 days in jail. During group, she contributes that none of this is her fault. Her mother is totally evil because she would not let Alexa stay in the family home. She has some other family, but they are all jerks because they won’t help her. Alexa’s friend Melanie is the absolute best person in the world, but she can’t help because her boss fired her for no reason. Alexa has a history of arrests for buying illegal drugs and prostitution. The last time she was in jail, her sentence was extended for 30 days because she got into a fight with another inmate and beat her up so badly she had to be admitted to the hospital for 6 days. The PMHNP considers which of the following personality disorders? a) Histrionic b) Narcissistic c) Borderline d) Schizoid Question 2 Anne is a 32-year-old female who presented to care after a random drug screening at work was positive for cocaine. She was initially resistant to therapy, maintaining that her use is not a problem and she could stop at any time. Upon further discussion in session, it appears that she uses cocaine every day at work, sometimes 2–3 times, other days more. She also uses it occasionally at home and most weekends. During her third session, she admitted that it is a financial burden, and she basically cannot afford any other form of recreation. She understands that if she uses again she will lose her job, and she admits that she loves her job and that cocaine is not worth losing it. When counseling her about cessation strategies, the PMHNP advises all the following except: a) The physiologic symptoms of withdrawal may require a short-term hospitalization b) Unlike other substances of abuse, there are no medications to help reduce the intensity of withdrawal c) She will need to be monitored for depression d) Overcoming the intense craving for cocaine is the biggest issue about:blank 5/34 c) Antiadrenergic d) Antipsychotics Question 7 The PMHNP is on call at the local county correctional facility. He is asked to evaluate M.S., a 21-year-old male who was just arrested following an altercation at a local bar. M.S. has never been incarcerated before and apparently has no psychiatric or medical history available. His toxicology screen was negative for alcohol or any drugs of abuse. His mother says that he has in the past had some occasions when he got kind of agitated, but this is the first time it’s been a problem. Reportedly some people from his office were at the bar celebrating a birthday, and before anyone knew what happened an argument escalated into M.S. getting very loud, yelling, and acting ―crazy‖ before he punched a coworker and started breaking bottles. When considering a manic or hypomanic episode, the PMHNP expects that his speech would most likely be: a) Stuttered b) Increased c) Childlike d) Confused Question 8 Fletcher is a 29-year-old male referred for court- about:blank 6/34 ordered counseling. He has a long history of repeated offenses including DUI, domestic violence, battery, and other violent acts that fortunately, have not yet caused any serious injury or death to the recipients. An interview with his wife reveals that he has lied about almost everything for the last few years; he is able to get hired for jobs because he is very engaging and likeable, and then invariably he gets fired because he misses work and doesn’t do his job properly when he is there. According to the wife, they have known each other since high school, where Fletcher was very happy and well-adjusted. He was on the soccer team, liked by teachers, and never demonstrated the tendencies he does now. Apparently in college he got involved with a fraternity that was notorious for alcohol and drug abuse, and he started drinking heavily; it was ―all downhill from there.‖ The PMHNP considers that: a) History and symptoms are most consistent with antisocial personality disorder b) Fletcher needs a neurological workup to include an EEG and assessment for neurological soft signs c) Consistent with his symptoms, Fletcher will likely respond well to a stress interview d) It is likely that substance abuse is the underlying cause of symptoms and should be explored further about:blank 7/34 Question 9 Which among the following neurotransmitters is decreased in depression and increased in mania? a) Dopamine b) Norepinephrine c) Serotonin d) Glutamate Question 10 Among the various types of therapeutic intervention for patients with borderline personality disorder, which of the following is characterized as polymodal, including group skills training, individual therapy, telephone consultation, and a consultation team with a goal of improving interpersonal skills and decreasing self-destructive behavior? a) Mentalization-based treatment (MBT) b) Transference-focused psychotherapy (TFP) c) Countertransference-focused psychotherapy (CTFP) d) Dialectical behavioral therapy (DBT) Question 11 Mr. Kendall is a 47-year old male who is presented to care by his younger sister, Megan. Mr. Kendall has spent his entire adult life living in an apartment that was attached to his parents’ home. His mother died a few weeks ago, and the property is listed for sale. Mr. Kendall will have to move, and while discussing this about:blank 10/34 cannot be late. The PMHNP considers that Darius may have obsessive compulsive personality disorder (OCPD). In differentiating this from obsessive compulsive disorder (OCD), she explores his history further for: a) A history of racing thoughts b) Difficulty interacting with others c) Extremely high expectations of self d) Significant impairment at work 7 Question 15 Hugo is a 39-year-old male who has encouraged his wife to come to counseling because he is worried about her wine drinking. Hugo says that he and his wife have shared a bottle of wine with dinner most nights for the last couple of years, but in the last few months he has become worried that she drinks too much. They both agree that she never really becomes intoxicated, but he does not like the fact that evening wine has become the most important part of her meal. If he wants to go out, she will only go to a place that has a wine she likes. Last month they went on a week-long vacation, and she insisted on packing enough of her wine to last the whole time. If they go to a restaurant that does not have a wine she likes, she will take her own in a disposable coffee cup. It seems like for the last few months, she has been drinking more and more, occasionally finishing the bottle alone when he doesn’t want any. Both partners agree that there is no interference with work or any activities or responsibilities, but it is causing some about:blank 11/34 tension in their marriage. When considering a diagnosis of substance use disorder, the PMHNP considers that: a) Hugo’s wife meets diagnostic criteria for this disorder b) A trial period with no wine ingestion is necessary to assess for withdrawal symptoms c) The family history should be assessed for genetic tendency d) Hugo may have unreasonable expectations Question 16 When developing a pharmacologic treatment plan for the management of major depressive disorder, the PMHNP counsels the patient that the medication will be titrated up to the appropriate dose and then continued for a minimum of 3 months; medication must not be stopped abruptly or without provider supervision. This is because the physiologic consequence of abrupt cessation is likely to result in: a) Antidepressant discontinuation syndrome b) Rebound depressive symptoms c) A manic or hypomanic episode d) Unresponsiveness to medication with future episodes about:blank 12/34 Question 17 Which of the following is a true statement with regard to the etiology of substance abuse? a) Neurotransmitters or receptors have been identified with most substances of abuse except for alcohol b) Twin and sibling studies do not support a genetic component with respect to the etiology of substance abuse c) Substances of abuse decrease activity in the amygdala and anterior cingulate d) The WHO schematic of drug use and dependence identifies immediate antecedents as the central element of abuse Question 18 Assessment of the manic state in a patient with bipolar disorder is likely to include all the following except: a) Mood-congruent delusions of grandeur b) Suicidal or homicidal ideation c) Impaired judgment with no insight about:blank 15/34 b) Pimozide c) Psychotherapy d) Group therapy Question 22 Margo is a 47-year-old female who admits to a history of fairly heavy alcohol use over many years. She admits that she has had periods in the past where she stopped drinking for a brief time, but she has always gone back to it. At this point she says she has been drinking a fifth of bourbon every 2–3 days for over a year. She has a new boyfriend and really wants to stop drinking, but she is afraid she will ―go into the DTs.‖ She has been reading about it on the Internet, and she knows it can be fatal. Other than her drinking, Margo is amazingly healthy. She had a complete physical exam with blood work through her primary doctor, and he says that her drinking does not appear to have affected her physical health at all. While counseling Margo about alcohol withdrawal delirium (delirium tremens), the PMHNP advises Margo that: a) She should be admitted for inpatient detoxification b) People in good physical health rarely have DTs c) A beta adrenergic antagonist medication can minimize her risk of DTs d) Women rarely experience DTs about:blank 16/34 Question 23 Anthony is a 41-year-old male patient who presents for evaluation. His wife made the appointment because she is worried about him and he would not seek care on his own. Anthony has become progressively withdrawn over the last few months and is in danger of losing his job because he misses so many days. He has been evaluated by his primary care provider and has no apparent medical conditions. His wife reports that he has been diagnosed with depression in the past, and has even taken medication that seemed to help. This time he just refused to pursue care. After a comprehensive assessment, the PMHNP diagnoses the patient with major depressive episode with psychotic features. Consistent with the Texas Algorithm Medication Project (TAMP), the appropriate choice of initial medication therapy would be: a) Venlafaxine and clozapine b) Fluoxetine and olanzapine c) Amitriptyline and haloperidol about:blank 17/34 about:blank 20/34 about:blank 21/34 about:blank 22/34 about:blank 25/34 about:blank 26/34 about:blank 27/34 about:blank 30/34 about:blank 31/34 about:blank 32/34 about:blank 35/34 about:blank 36/34 about:blank 37/34