Q # 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? o Histrionic o Narcissistic o Borderline o Schizoid Q # 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: o The physiologic symptoms of withdrawal may require a short-term hospitalization o Unlike other substances of abuse, there are no medications to help reduce the intensity of withdrawal o She will need to be monitored for depression o Overcoming the intense craving for cocaine is the biggest issue Q #3 Clare’s history of personal relationships is characterized by complete intolerance of being alone. Whether it is an intimate-partner relationship or a close friend, Clare appears to always need someone in her life. She had a live- in boyfriend of 3 years, and while they were together, he took care of everything. The PMHNP expects all of the following to be additional features of Clare’s history except: o Has difficulty disagreeing with others o Needs reassurance to support even mundane decisions o Volunteers to do unpleasant tasks to obtain nurturance o Has disproportionate anger toward an abusive spouse Q # 4 The PMHNP is conducting an initial interview with a patient whose history is consistent with avoidant personality disorder. The PMHNP understands that one of the most striking features of this interview is likely to be centered upon the patient’s: o Clothing o Speech pattern o Anger o Anxiety Q # 5 A PMHNP student is reviewing his notes from his clinical experience over the past week to prepare his first required case presentation on a patient suffering a major depressive episode. Which of the following patients best represents the DSM-5 criteria for major depressive episode? o A 27-year-old female with a 1-month history of social withdrawal, anorexia, hypersomnia, unprovoked outbursts of anger, and a strong family history of endogenous depression o A 41-year-old male with a history of childhood sexual abuse, loss of interest in both his professional and personal life, an unplanned 10 lb. weight loss in the last 3 months, and perceptual disturbances o A 65-year-old male whose wife died 2 months ago and he reports a 3-week history of generally depressed mood, guilt about his wife’s death, insomnia, difficulty focusing on daily tasks, with increasing thoughts of dying o A 72-year-old female who just relocated across country to live with her adult son and daughterin-law who is despondent about leaving her home and reports forgetfulness, loss of appetite, new onset bowel problems, and extreme loss of energy Q # 6 A variety of pharmacologic agents have demonstrated effectiveness in the treatment of post-traumatic stress disorder. Which of the following does not have any evidenced-based support in the literature? o SSRIs o TCAs o Antiadrenergics o Antipsychotics Q # 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: o Stuttered o Increased o Childlike o Confused Q # 8 Fletcher is a 29-year-old male referred for court-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: ‖ o History and symptoms are most consistent with antisocial personality disorder o Fletcher needs a neurological workup to include an EEG and assessment for neurological soft signs o Consistent with his symptoms, Fletcher will likely respond well to a stress interview o It is likely that substance abuse is the underlying cause of symptoms and should be explored further Q # 9 Which among the following neurotransmitters is decreased in depression and increased in mania? o Dopamine o Norepinephrine o Serotonin o Glutamate Q # 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? o Mentalization-based treatment (MBT)