Psychiatric Advanced Practice Nursing A Biopsychosocial Foundation for Practice -1st Edition by Eris F. Perese -Test Bank

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Psychiatric Advanced Practice Nursing A Biopsychosocial Foundation for Practice -1st Edition by Eris F. Perese -Test Bank

 

Sample  Questions

 

Chapter 3: Postnatal influences on development of psychopathology

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   It is known that childhood exposure to maltreatment

A. Is associated with increased rates of physical and psychiatric disorders
B. Occurs in 10% of U.S. children
C. Is most often exposure to sexual abuse
D. Usually involves a perpetrator who is unknown to the child

 

 

____    2.   Genetic influence on prenatal brain development is different for different areas of the brain and may underlie psychopathology. There is strong genetic influence on the development of which of the following areas?

A. Sensorimotor
B. Cerebellum
C. Frontal cortex
D. Corpus callosum

 

 

____    3.   Cell synaptogenesis refers to

A. Birth of new neuronal cells
B. Migration of neurons
C. Programmed cell death
D. Establishment of connections between neurons

 

 

____    4.   In considering fetal exposure to prenatal risk factors, it is known that

A. Damage due to maternal stress is greatest during the third trimester.
B. Nutritional deficits can damage the brain as well as the spinal cord.
C. Radiation exposure has no effect on brain development during the first trimester.
D. There are safe periods of time for maternal consumption of alcohol.

 

 

____    5.   Premature birth disrupts brain development in specific areas. Disruption of brain development in the sensorimotor area is thought to be associated with later development of

A. Cerebral palsy
B. Language impairment
C. Hearing impairment
D. Depression

 

 

____    6.   Impairment of ability to self-regulate emotions is thought to be related to

A. A slow-to-warm-up temperament
B. An insecure pattern of attachment
C. Poverty and poor housing
D. An authoritarian style of parenting

 

 

____    7.   In the biopsychosocial theory of the development of psychiatric disorders, it is proposed that psychiatric disorders are due to a combination of

A. Exposure to adverse experiences and a large social support network
B. Compromised brain development and adverse experiences
C. Small family size and challenging learning experiences
D. Democratic parenting style and limited financial resources

 

 

____    8.   Among children who have experienced chronic exposure to family violence, it has been found that

A. The children may lack capacity for emotional self-regulation.
B. Most of the children are able to integrate their experiences into a positive inner model of the world.
C. As adolescents, they have lower rates of aggressive behavior problems.
D. The rate of adult psychopathology is the same as that of the general population.

 

 

____    9.   Among children who use an accommodating response to maltreatment, there is increased likelihood of impaired capacity for

A. Controlling impulsivity
B. Knowing their own feelings and emotions
C. Showing regressive behaviors
D. Integrating memories of pain and fear

 

 

____  10.   Following prenatal exposure to neurotoxic drugs, an adverse effect that is shared by   many infants is

A. Abnormalities of finger ridges
B. High-steepled palate
C. Microencephaly
D. Curved little finger

Chapter 5: Case Formulation and Diagnosis, Differential Diagnoses and Developing a Biopsychosocial Plan of Care

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   The primary function of a biopsychosocial case formulation is to

A. Generate an understanding of the person as a whole
B. Identify comorbid medical illnesses
C. Assess the maturity of the patient’s defense mechanisms
D. Determine patient’s level of social support

 

 

____    2.   The primary purpose of a biopsychosocial case formulation is to

A. Predict response to different treatment modalities
B. Organize key facts around a cause, the source of the problem
C. Provide information required for reimbursement
D. Determine the level of care required

 

 

____    3.   Sociocultural factors have the strongest influence on

A. How diagnosis of a psychiatric disorder is accepted
B. The age of onset of symptoms of a psychiatric disorder
C. The gender distribution of the disorder
D. Prediction of response to psychoeducation

 

 

____    4.   In a biopsychosocial case formulation, social contributions would be considered to be

A. Genetic influences and adverse circumstances of birth
B. Substance use and medical disorders
C. Cognitive deficits and dysregulation of emotions
D. Religious/cultural factors and living situations

 

 

____    5.   A predisposing event would be all of the following except

A. Early prolonged separation from the mother
B. Having been born unwanted
C. Recent arrests or incarcerations
D. History of childhood neglect or abuse

 

 

____    6.   A precipitating event might be

A. Financial losses or loss of housing
B. Chronic health problems
C. Childhood separations and anxiety disorders
D. Genetic influences and premature birth

 

 

____    7.   Mechanisms that maintain a problem are biopsychosocial causes or sources of the problem. Psychological causes might include

A. Poverty and social isolation
B. Impaired neural circuitry
C. Impaired ability to regulation emotions
D. Abnormalities of neurotransmission

 

 

____    8.   Effective case formulation outcomes are stated

A. In terms of behaviors that must be changed
B. As incorporating efforts of others to achieve goal
C. In broad terms such as life satisfaction
D. As directly related to patients’ identified problem or problems

 

 

____    9.   In developing a biopsychosocial plan of treatment, focus in the biological domain is on

A. Identification and treatment of comorbid medical illnesses
B. Social skills training and social support enhancement
C. Vocational rehabilitation and supported employment
D. Interpersonal therapy or cognitive behavioral therapy

 

 

____  10.   In the problem-oriented method of case formulation, the patient’s problems are defined as a solvable target of treatment. Which of the following is an example of a problem-oriented case formulation description?

A. “Lack of interpersonal communication skills”
B. “Due to early childhood conflicts”
C. “Due to use of immature defense mechanisms”
D. “Caused by stigma and discrimination”

Chapter 7: Psychotherapies

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   The primary purpose of psychotherapy is to facilitate changes by the patient in order to

A. Reduce symptoms of distress
B. Address identified problems
C. Reduce burden on the family
D. Improve vocational functioning

 

 

____    2.   Which of the following statements provides the most appropriate comment about therapists’ sharing of personal information with patients?

A. Sharing may be used to enhance trust or show interest.
B. Sharing may be used to show that the therapist has similar difficulties.
C. Sharing may include offering friendship outside of sessions.
D. Sharing may be used to reduce therapists’ discomfort with silence in the session.

 

 

____    3.   Among factors believed to be involved in the development of psychopathology, which of the following factors is most amenable to psychotherapy?

A. Temperament
B. Genetic influenced brain development
C. Adverse circumstances of birth
D. Mastery of psychosocial tasks at different ages

 

 

____    4.   Which of the following criteria would preclude the use of brief dynamic therapy?

A. Adequate ego strengths
B. Psychological problems in multiple domains
C. Use of mature defense mechanisms
D. Adequate ability to process information

 

 

____    5.   Among the following disorders, which one would most likely be amenable to brief dynamic therapy?

A. Bipolar disorder
B. Substance dependence
C. Psychotic disorder
D. Avoidant personality disorder

 

 

____    6.   Brief psychotherapy refers to a category of psychotherapies that brings about changes in patients through

A. Therapist-initiated, focused, emotionally corrective interventions
B. Helping patients to develop an understanding of childhood conflicts
C. Participation of family members in treatment sessions
D. Helping patients to develop insight through self-exploration

 

 

____    7.   The core principle of relational therapies that include psychodynamic psychotherapy and interpersonal psychotherapy is that current problems reflect

A. Learned behavioral responses
B. Failure to integrate life experiences
C. Problems with relationships with others
D. Distorted perceptions of ability to cope

 

 

____    8.   In cognitive therapy, therapists focuses on patients’

A. Use of immature defense mechanisms
B. Learned behavior of helplessness
C. Automatic negative thoughts
D. Attachment patterns

 

 

____    9.   In supportive therapy, the focus is on

A. Strengthening self-esteem and ego functioning
B. Promoting insight
C. Remediating cognitive functioning
D. Exposure and response prevention

 

 

____  10.   Psychotherapy is a form of learning that has the potential to do all of the following except

A. Alter gene expression
B. Influence production of neurotransmitters
C. Promote creation of new synaptic connections
D. Eradicate traumatic memories

Chapter 9: Response to Stressors: Bridging Normal Responses and Psychiatric Disorders

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   The key feature of adjustment disorder is

A. An anxiety response to a social event such as speaking in public
B. The response to a known stressor that occurs within 3 months of the stressor
C. A response to an event that is catastrophic, such as witnessing a murder
D. Pervasive anxiety related to a fear of being trapped in an enclosed place

 

 

____    2.   Adjustment disorder is often associated with

A. Symptoms of dissociation
B. Time lost from work
C. Flashbacks and nightmares
D. Delusions of persecution

 

 

____    3.   In general, the treatment of choice for adjustment disorder is

A. Pharmacotherapy
B. Light therapy
C. Psychotherapy
D. Electroconvulsive therapy

 

 

____    4.   Patients who use direct methods of coping strategies when confronted with a stressful event would likely engage in

A. Seeking to understand the value to be extracted from negative experiences
B. Following the steps of problem-solving
C. Increasing their sense of control over the situation
D. Asking other people to manage the situation

 

 

____    5.   It can be said of exposure to traumatic events that

A. The majority of people develop some form of psychopathology.
B. The development of adjustment disorder is likely to follow exposure to life-threatening traumatic events.
C. The normal reaction includes grief, anxiety, and thoughts of suicide.
D. Cognitive appraisal and style of coping have greater influence on outcome than the physical aspects of the traumatic event.

 

 

____    6.   The response of exposure to stressors

A. Is the same response in all humans
B. Is the same for males and females
C. Is followed by homeostasis
D. Is buffered by the presence of three or more social contacts

 

 

____    7.   The process of allostasis includes

A. Mobilization of energy, activation of cognition, and behavioral changes
B. Reduction of production of cortisol
C. Decreased levels of norepinephrine
D. Development of a state of exhaustion

 

 

____    8.   The fear/anxiety circuit of the brain includes which of the following brain structures?

A. Reticular activating system
B. Amygdala and hippocampus
C. Parietal lobe and cerebellum
D. Corpus callosum

 

 

____    9.   Complicated grief differs from normal grief by the presence of

A. Emotions of anger and regret
B. Persistent longing and yearning for the deceased
C. Physical symptoms of headaches and indigestion
D. Problems with concentration and planning

 

 

____  10.   An important evidence-based finding about adjustment disorder among adolescents and young adults is that

A. Pharmacotherapy is the frontline for treatment.
B. The course of adjustment disorder is brief, with good outcomes.
C. There is a short time between thoughts of suicide and carrying out suicide.
D. Academic functioning is well preserved.

Chapter 11: Acute Stress Disorder and Posttraumatic Stress Disorder

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   Which mental status variation are you most likely to expect for a client diagnosed as having post-traumatic stress disorder?

A. Thought: delusions of grandeur
B. Perceptual: derealization and depersonalization
C. Memory: impaired recent memory
D. Mood: inappropriate, silly

 

 

____    2.   Three days ago, a woman was raped by a man who drove her home from a party. She notified the police and the man was arrested. She has memory loss related to the rape and feels depressed and lethargic. Which of the following would be the most immediate beneficial intervention?

A. Providing an opportunity to confront her assailant
B. Providing medication
C. Referring her to a support group
D. Creating a safe environment

 

 

____    3.   The key feature of acute stress disorder is the presence of

A. Sleep disturbances
B. Symptoms of dissociation
C. Increased arousal
D. Recurrent, intrusive thoughts

 

 

____    4.   The current frontline treatment for acute stress disorder is

A. Mood stabilizer medications
B. Interpersonal psychotherapy
C. Antianxiety medications
D. Trauma-focused cognitive behavioral therapy

 

 

____    5.   Following exposure to a traumatic event, post-traumatic stress disorder occurs more often

A. Among men
B. Among individuals who have experienced prior traumas
C. Among individuals with high levels of education
D. Among those who are married or in a stable relationship

 

 

____    6.   The brain structure that is involved with encoding the time and place of a trauma is the

A. Amygdala
B. Thalamus
C. Hippocampus
D. Hypothalamus

 

 

____    7.   The model of psychotherapy that is most effective for acute post-traumatic stress disorder is

A. Supportive psychotherapy
B. Exposure therapy
C. Stress inoculation therapy
D. Debriefing therapy

 

 

____    8.   Ninety percent of Americans experience a trauma in their lifetime that is severe enough to cause post-traumatic stress disorder. What percent develop post-traumatic stress disorder?

A. 10%
B. 20%
C. 30%
D. 40%

 

 

____    9.   The primary goal of treatment for patients with post-traumatic stress disorder is to help them to

A. Eradicate memories of the traumatic event
B. Prevent response to triggers of the traumatic event
C. Learn to live with intrusive images
D. Place the trauma in the larger perspective of their lives

 

 

____  10.   Which one of the following exposure treatments for post-traumatic stress disorder has been   found to be effective among veterans with chronic post-traumatic stress disorder that has not responded to other forms of treatment?

A. Cognitive behavioral therapy
B. Eye movement desensitization and reprocessing therapy
C. Structured writing therapy
D. Virtual reality exposure therapy

Chapter 13: Depressive disorders

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   Compared with unipolar depression, the depressed phase of bipolar disorder

A. Has a later onset
B. Has a more gradual onset
C. Carries a greater risk for suicide
D. Is less frequently accompanied by psychotic symptoms in younger patients

 

 

____    2.   The patient says that she has been feeling sad and having difficulty sleeping over the past 6 weeks. She says she has lost her appetite and has lost about 10 lb. This is the first time she has felt this way and she cannot recall any specific unsetting event. Given this minimal information, an initial diagnosis might be

A. Adjustment disorder with depression
B. Seasonal affective disorder
C. Major depression, single episode
D. Major depression with catatonic features

 

 

____    3.   A patient says that she has been becoming increasingly depressed following the birth of her first child 4 months ago. She had an episode of depression in her 20s but recovered. Now, she is becoming more despondent, crying, and sleeping a lot. She fears that she may hurt the baby if she does not get treatment. A possible diagnosis is

A. Major depressive disorder with melancholic features
B. Major depressive disorder with psychotic features
C. Dysthymia with superimposed major depression (double depression)
D. Major depressive disorder with postpartum onset

 

 

____    4.   Core symptoms of complicated grief include experiencing which of the following symptoms more than 6 months after the death?

A. Feeling that life has no meaning without the deceased
B. Prominent self-blaming thoughts for not having prevented the death
C. Dissociative states in which the deceased is believed to be present
D. All of the above

 

 

____    5.   Which of the following is a frontline treatment for insomnia in depressed elderly individuals?

A. Sleep hygiene
B. Benzodiazepines
C. Zolpidem
D. Trazodone

 

 

____    6.   Electroconvulsive therapy has been found to be effective in which of the following conditions?

A. Depression with melancholic features
B. Dysthymia
C. Seasonal affective disorder
D. Atypical depression

 

 

____    7.   A young adult who works as a court reporter describes herself as being depressed most of the time and says she has been that way since her teens. She denies any weight loss or sleep disturbances. She describes problems with concentration, difficulty making decisions, and lack of energy that are causing her problems at work. Which of the following is the most likely diagnosis?

A. Dysthymia
B. Major depressive disorder with seasonal pattern
C. Major depressive disorder with atypical features
D. Major depressive disorder with melancholic features

 

 

____    8.   Which one of the following somatic therapies is no longer used to treat depression?

A. Transcranial magnetic stimulation
B. Electroconvulsive therapy
C. Insulin shock therapy
D. Phototherapy (light therapy)

 

 

____    9.   Post’s theory of depression states that early experience may make the brain more sensitive to future stressors and to recurrence of depressive episodes. This theory is often referred to as

A. Kindling theory
B. Dysregulation theory
C. Anger turned inward theory
D. Learned helplessness theory

 

 

____  10.   The patient says that for the last 5 years, she has begun to feel depressed around the time the golf season ends in November and begins to feel better when she is able to get outdoors to play again in April. When she is depressed, she craves carbohydrates, overeats, and gains weight. She has no energy and wants to sleep all the time and she is irritable and snaps at people. The psychiatric advanced practice nurse considers which of the following diagnoses?

A. Dysthymia
B. Major depressive disorder with seasonal pattern
C. Adjustment disorder with depressed mood
D. Major depressive disorder with atypical features

 

 

____  11.   A patient who has been taking venlafaxine (Effexor) for major depressive disorder with melancholic features says that suddenly he can’t sleep and spends hours writing to his congressman with his ideas of how to reduce the national debt. The psychiatric advanced practice nurse considers all of the following but selects which one as the most likely explanation for the change in his clinical presentation:

A. Nonadherence with venlafaxine
B. Emergence of symptoms of hypomania
C. Emergence of symptoms of a personality disorder
D. Increasing severity of symptoms of depression

 

 

____  12.   In teaching about the management of the care of a patient with major depressive disorder who has expressed thoughts of suicide, the psychiatric advanced practice nurse emphasizes that the risk is greatest

A. When the depression most severe
B. Before any kind of somatic treatment is started
C. When the patient expresses feelings of sadness or is tearful
D. When the patient begins to feel more energetic

Chapter 15: Schizophrenia and Schizoaffective Disorder

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   Men with schizophrenia have

A. An older age of onset
B. Fewer negative symptoms
C. A more favorable premorbid history
D. A less favorable course

 

 

____    2.   It has been suggested that reduced volume of the temporal lobe is related to

A. Persistence of negative symptoms
B. Severity of auditory hallucinations
C. Deficits in working memory
D. Impairment of motor coordination

 

 

____    3.   Abnormalities of motor function characterized by a marked lack of motion or remaining in one posture are most characteristic of which subtype of schizophrenia?

A. Paranoid
B. Catatonic
C. Disorganized
D. Undifferentiated

 

 

____    4.   A patient who has just been started on Haldol 5 mg po bid is complaining of a sudden painful stiff neck and jaw muscles. This is most likely

A. Akinesia
B. Akathisia
C. Dystonia
D. Somatization

 

 

____    5.   When used for treatment of a patient with schizophrenia, typical antipsychotics could be expected to be most effective for which of the following symptoms?

A. Social isolation
B. Ineffective individual coping
C. Hallucinations
D. Lack of ability to make decisions

 

 

____    6.   Which of the following features is associated with positive outcome among patients with schizophrenia?

A. Younger age of onset
B. Male gender
C. Living in an industrialized country
D. Having positive symptoms

 

 

____    7.   An atypical antipsychotic would be expected to work better than a typical antipsychotic for which of the following symptoms?

A. Hallucinations
B. Delusions
C. Paranoia
D. Cognitive dysfunction

 

 

____    8.   A patient states that she hears voices telling her that she should kill herself. The psychiatric advanced practice nurse states that the patient is

A. Experiencing delusions
B. Experiencing hallucinations
C. Experiencing an aura
D. Experiencing a dissociative state

 

 

____    9.   A patient who is being evaluated in the emergency room says that she is a mother deity, the earth mother god who is all-powerful. The psychiatric advanced practice nurse states that the patient is

A. Experiencing a delusion
B. Experiencing a hallucination
C. Experiencing impaired impulse control
D. Experiencing an acute stress reaction

 

 

____  10.   Brain imaging techniques have revealed which one of the following anatomic changes in some people with schizophrenia?

A. Increased blood flow in the prefrontal area
B. Increased ventricular size
C. Increased brain activity in the frontal area
D. Enlargement of the thalamus

Chapter 17: Dual Diagnosis

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   The area of the brain that is involved in substance abuse is the reward center of the brain, which includes the

A. Brainstem
B. Thalamus
C. Cerebellum
D. Ventral tegmental area

 

 

____    2.   The common pathway of reinforcement and reward that is believed to be involved in substance-related disorders is the

A. Mesocortical dopamine pathway
B. Mesolimbic dopamine pathway
C. Tuberinfundibular dopamine pathway
D. Nigrostriatal dopamine pathway

 

 

____    3.   The action produced by cocaine that can cause symptoms of paranoia and hallucinations similar to symptoms of schizophrenia is related to

A. Increase of dopamine
B. Decrease of dopamine
C. Increase of norepinephrine
D. Decrease of glutamate

 

 

____    4.   The clinical effects and withdrawal symptoms of amphetamines are similar to those of

A. Heroine
B. Alcohol
C. Cocaine
D. Marijuana

 

 

____    5.   The areas of the brain considered to be most involved in the development of substance abuse are the

A. Brainstem and reticular activating system
B. Thalamus and hypothalamus
C. Ventral tegmental area and nucleus accumbens
D. Cerebellum and olfactory bulb

 

 

____    6.   Which of the following brain nuclei is involved with pleasure and addiction?

A. Red nucleus
B. Hypothalamus
C. Substantia nigra
D. Nucleus accumbens

 

 

____    7.   Current treatment approaches for dual diagnosis or co-occurring disorders focuses on

A. Identifying primary disorders and treating them first
B. Treating psychiatric disorders and substance-related disorders separately
C. Treating all co-occurring disorders as primary disorders
D. Treating psychiatric disorders first

 

 

____    8.   It is known that high levels of alcohol consumption

A. Exacerbate psychiatric symptoms
B. Improve circulation
C. Reduce the risk for developing dementia
D. Reduce the risk of suicide among older adults

 

 

____    9.   Which of the following medications used to decrease alcohol consumption interferes with the metabolism of alcohol?

A. Naltrexone (ReVia)
B. Disulfiram (Antabuse)
C. Acamprosate (Campral)
D. Extended-release naltrexone injection

 

 

____  10.   Symptoms of alcohol withdrawal

A. Are most severe 8 to 10 hours after last drink
B. Are most severe 24 to 28 hours after last drink
C. Include hallucinations among 50% of individuals
D. Are evidenced as delirium tremens 2 weeks after the last drink