NR546 Actual Final Exam -with 100

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NR546 Actual Final Exam -with 100% verified solutions- -

• A 14-year-old patient has nonspecific complaints about pain in his or her legs. The physical

examination is unremarkable. Laboratory results are within normal limits except for a markedly elevated

alkaline phosphatase level. The psychiatric-mental health nurse practitioner:

interprets the findings as normally occurring during a rapid adolescent growth spurt.obtains a rheumatoid profile because elevated alkaline phosphatase is a sign of early rheumatic fever.orders a repeat blood test.suspects that the patient has acute pancreatitis.

• Laboratory findings for a patient with an alcohol use disorder indicate increased liver function values

and:

a decreased mean corpuscular volume (MCV) and normal triglyceride levels.elevated potassium and chloride levels.increased MCV and elevated triglyceride levels.increased urine and serum creatinine levels.

• A new patient arrives at the office for treatment for depression. The patient reports taking simvastatin

(Zocor) and lisinopril (Zestril). When selecting an antidepressant, the psychiatric-mental health nurse practitioner eliminates fluoxetine (Prozac), based on the knowledge that the combination can lead to increased plasma levels of the statin, resulting in an increased risk of muscle damage and

rhabdomyolysis. The nurse practitioner's reason is that:

both medications are CYP450 3A4 inhibitors.both medications are CYP450 3A4 substrates.one medication is a CYP450 3A4 substrate and one is a CYP450 3A4 inducer.one medication is a CYP450 3A4 substrate and one is a CYP450 3A4 inhibitor.

• During a mental status examination, an 18-year-old patient reports feeling bugs crawling under the

skin. The psychiatric-mental health nurse practitioner documents this statement as:

a developmental disorder, and suspects cocaine use.a hypnagogic hallucination, and suspects schizophrenia.a hypnopompic hallucination, and suspects schizophrenia.a perceptual disturbance, and suspects the use of cocaine.

• The psychiatric-mental health nurse practitioner is responsible for initiating quality improvement at a

community mental health clinic. The effective strategy for evaluating the clinic's services is to:

analyze the data from epidemiological studies.conduct a root cause analysis.

interview patient families.use a survey to elicit patient satisfaction responses.

• The psychiatric-mental health nurse practitioner evaluates a new adult patient via telemedicine. The

patient has questions about a new medication that he or she recently started. The nurse practitioner

decides to provide psychoeducation and to:

e-mail drug information and resources.encourage the patient to seek information on the internet.have a phone conference with a family member.refer patient to a local primary care provider.

• Any court of law that evaluates the standards of care provided by the psychiatric-mental health nurse

practitioner:

compares the actions to the standard of care provided by a psychiatrist.considers what a reasonably prudent health care provider would do.evaluates patient satisfaction data.reviews the nurse practitioner's charts for similar patients.

• The psychiatric-mental health nurse practitioner and a team of local mental health professionals are

asked to provide crisis counseling service, after a gunman recently took a class hostage at a local elementary school, wounded several students, and then shot himself. In preparing for this assignment,

the nurse practitioner recognizes that:

a child's developmental stage will influence his or her response to catastrophic stress.a child's lack of an emotional response to a catastrophic event is a predictor of negative long-term consequences.it is necessary for the child's guardian to be present.the event is more important to the child than whether he or she suffered physical harm.

• Which community-based program is a tertiary level intervention?

Educational sessions at the local community mental health center.National Association of Mental Illness meetings that provide education and support.Partial hospitalization program that provides intensive group therapy for rehabilitation.Twelve-step organization support meetings, such as Alcoholics Anonymous.

• A 32-year-old female patient informs the psychiatric-mental health nurse practitioner that she is three

months pregnant. She has been stable on fluoxetine (Prozac) for the last two years. The patient asks whether she may safely continue this medication during her pregnancy. The nurse practitioner responds:

"At this time, Prozac is safe for you to continue during your pregnancy." "Cognitive-behavioral therapy has proven to be successful during pregnancy with no risk to the fetus, so let's discontinue your Prozac." "Let's review the risks and benefits of continuing or discontinuing Prozac for you and the fetus." "This medication is unsafe for the fetus, so we'll wean you off this medication during your pregnancy."

• Established clinical guidelines suggest that suicidality is decreased by treating patients who have

borderline personality disorder with:

eye movement desensitization reprocessing.cognitive-behavioral therapy.dialectical behavioral therapy.interpersonal therapy.

• A six-year-old patient with autism spectrum disorder has not responded to six months of psychosocial

interventions and continues to demonstrate aggressive tendencies toward a younger sibling. The

psychiatric-mental health nurse practitioner prescribes:

carbamazepine (Tegretol) 200 mg once a day.haloperidol (Haldol) 2 mg once a day.risperidone (Risperdal) 0.25 mg once a day.venlafaxine ER (Effexor XR) 37.5 mg once a day.

• The psychiatric-mental health nurse practitioner working in a crisis stabilization unit evaluates a

patient verbalizing suicidal thoughts after being sexually assaulted. Before processing through the

traumatic event, the nurse practitioner first attempts to:

provide an environment of safety.incorporate psychoeducation to address emotional dysregulation.promote cultivation of coping strategies to enhance distress tolerance.provide intense psychotherapy.

• The psychiatric-mental health nurse practitioner uses a cognitive-behavioral approach to help a

patient address self-defeating behaviors. After identifying the stressor that causes the inappropriate

behavior, the initial strategy is to explore:

alternative positive responses to the stressor.negative consequences of the responses to the stressor.possible outcomes of alternative responses.rational and irrational beliefs about the stressor.

• A patient who has borderline personality disorder experiences intense anxiety when the psychiatric-

mental health nurse practitioner goes on vacation. The most appropriate explanation for this reaction is

that the patient:

employs primitive idealization.employs projective identification.has not developed clear ego boundaries.has not developed object constancy.

• An initial psychiatric evaluation of a patient reveals a normal mental status and appropriate behavior,