Psychiatric Advanced Practice Nursing A Biopsychosocial Foundation for Practice 1st Edition Perese Test Bank PDF

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Chapter 1: Theoretical Framework of Practice Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1. Temperament—a genetically influenced early form of personality—describes an infant’s pattern of

central nervous system responses and behaviors. Among the different types of temperament, which one is associated with more impairment of brain functioning and, in the absence of positive, nurturing parenting, is a risk factor for later development of psychiatric disorders? A. Easy B. Slow-to-warm-up/inhibited C. Mixed D. Difficult ____

2. According to psychosocial developmental theory, in the recently described “ninth age of man,”

beyond the life cycle, A. There are no further tasks to accomplish. B. The tasks that are the most important are generative versus stagnation. C. There is an emphasis on intimacy versus isolation. D. Tasks include overcoming life transitions. ____

3. Which attachment pattern is more likely to be found among children who have been abused? A. Secure B. Inhibited C. Disorganized D. Avoidant

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4. Nobel Prize winner Eric Kandel demonstrated that the brain A. Is plastic before birth but becomes hard-wired at birth B. Has plasticity and can change during the first 3 years of life C. Has plasticity that allows it to make new connections in response to learning D. Is unable to make new connections after age 26

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5. The primary relevance of Bowlby’s attachment theory for psychiatric advanced practice nurses is

that A. B. C. D. ____

Toddlers develop primitive defense mechanisms such as denial. Toddlers develop an inner working model of how adults will respond to them. Toddlers face the psychosocial task of autonomy versus shame. Toddlers develop a fear of engulfment and enmeshment.

6. Early attachment experiences are transformed into inner working models of the self and mother by

age A. B. C. D.

7 years 5 years 3 years 1 year Page

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7. In a cantilevered model of needs such as Hansell’s model, A. Basic needs must be met first B. There is a hierarchy of needs C. Each need supports all other needs D. Self-actualization is the last need to be met

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8. Freud’s drive theory proposes that individuals are motivated by A. Basic drives for survival and reproduction. B. Need to reduce anxiety. C. Need to resolve interpersonal conflicts. D. Basic drives for altruism.

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9. Brain plasticity, which refers to the brain’s capacity to change in response to an event, A. Is the same for all individuals B. Involves physical changes of the brain C. Is absent in older adults D. Is independent of genetic influence

____ 10. It is believed that recovery can be promoted in children by all of the following except A. Teaching problem-solving skills B. Providing social support C. Limiting challenging experiences D. Providing structure to daily life ____ 11. The primary focus of the biopsychosocial model is A. Heritability of psychiatric disorders B. Domains of functioning C. Abnormalities of neurotransmission D. Abnormalities of systems and circuits

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Chapter 1: Theoretical Framework of Practice Answer Section MULTIPLE CHOICE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

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D D C C B D C A B C B

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Chapter 2: Neurobiological Theory of Psychiatric Disorders: Brain functioning, brain development and prenatal and perinatal factors disrupting brain development Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1. On evaluation, the patient appears to be having difficulty with working memory, planning, and

insight into his problems. The psychiatric advanced practice nurse recognizes that these symptoms are associated with problems with the A. Frontal lobe B. Temporal lobe C. Parietal lobe D. Occipital lobe ____

2. On mental status examination, the patient’s thoughts reveal lack of directedness, excessive details,

and difficulty with closure. This pattern is called A. Concrete thinking B. Circumstantiality C. Perseveration D. Thought blocking ____

3. The brain structure that is believed to have a gating/filtering function and is the area of the brain

through which all sensory information passes en route to various cortical areas is which of the following: A. Brainstem B. Reticular activating system C. Thalamus D. Hypothalamus ____

4. Which area of the brain is a very primitive in terms of evolution and is involved in swallowing,

arousal, and breathing? A. Parietal lobe B. Insula C. Cerebellum D. Brainstem ____

5. Which of these brain structures puts emotional meaning on a stimulus, forms emotional memories,

and is involved with rage and fear? A. Hippocampus B. Temporal lobe C. Amygdala D. Midbrain ____

6. The principal excitatory neurotransmitter in the central nervous system is A. Gamma-aminobuytric acid (GABA) B. Serotonin C. Glutamate

D. Acetylcholine ____

7. Which structure of the brain is involved in learning, processing information into memories, and

assigning the time and the place to memories? A. Hippocampus B. Olfactory bulb C. Limbic system D. Occipital lobe ____

8. Which one of the following is not one of the meninges, the three layers that cover the brain? A. Arachnoid B. Pia C. Reticular formation D. Dura

____

9. Which of the following structures provides for communication between the two hemispheres of the

brain? A. Lateral ventricle B. Basal ganglia C. Corpus callosum D. Hypothalamus ____ 10. Which of the lobes of the brain is primarily involved in auditory hallucinations? A. Occipital lobe B. Parietal lobe C. Frontal lobe D. Temporal lobe ____ 11. The function of this brain structure was formerly believed to be limited to maintaining balance and

learning motor skills but is now believed to be involved in learning and emotions and may be involved in autism. It is the A. Cerebellum B. Insula C. Corpus callosum D. Pons ____ 12. This area of the brain is called a system and is made up of the rim of the medial (innermost) portions

of the frontal, parietal, and temporal lobes and overlies the brainstem. It is involved with emotions and is referred to as the A. Ventricular system B. Limbic system C. Reticular activating system D. Blood-brain barrier system

Chapter 2: Neurobiological Theory of Psychiatric Disorders: Brain functioning, brain development and prenatal and perinatal factors disrupting brain development Answer Section MULTIPLE CHOICE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS:

A B C D C C A C C D A B

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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

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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

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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

is A. B. C. D.

Abnormalities of finger ridges High-steepled palate Microencephaly Curved little finger

many infants

Chapter 3: Postnatal influences on development of psychopathology Answer Section MULTIPLE CHOICE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS:

A C D B A B B A B C

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Chapter 4: Communicating, Interviewing and Assessing Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1. During an initial assessment, the relevant features of communication are its ability to A. Promote a therapeutic alliance and increase understanding. B. Prompt a disclosure of past successes and failures. C. Bring about changes in behavior. D. Educate the patient about what is important to disclose.

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2. During the initial assessment of a patient with schizophrenia, in response to the question “What

brought you to the clinic today?” a patient’s response of “the van” is an example of A. Poverty of speech B. Concrete thinking C. Oppositional behavior D. Tangentiality ____

3. Patients’ perceptual difficulties may have an adverse effect on the therapeutic alliance. Which of the

following is likely to have the greatest negative effect? A. The patient perceives the office seating arrangement as belittling. B. The patient perceives the clinician as being part of her delusional system. C. The patient perceives the sound in the hall as messages for the patient. D. The patient perceives the clinician’s glancing at his watch as nonvalidating. ____

4. Open-ended questions A. Are useful in obtaining direct responses B. Define the focus of interest C. Are useful in the beginning of an interview D. Define the boundaries of the therapeutic alliance

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5. Closed-ended questions A. Are used to gather specific information B. Allow the patient to talk without interruption C. Are characterized by the use of reflection D. Are used to obtain difficult or emotionally laden material

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6. In using the communication technique of reflection, the clinician A. Interprets the difference between a patient’s thoughts and his or her behaviors B. Repeats something that the patient has said to encourage the patient to give more

information C. Provides prompts such as “tell me more” D. Seeks more information in order to have a more clear understanding ____

7. Validation is a communication strategy used to A. Let the patient know that his or her feelings are reasonable. B. Evaluate change in symptoms or behaviors.

C. Prompt the patient to continue talking. D. Elicit more information about a response. ____

8. The purposes of the psychiatric interview include all except A. Gaining an understanding of the patient’s illness B. Obtaining information efficiently C. Providing education about psychiatric disorders D. Establishing a therapeutic alliance

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9. To encourage the patient to talk freely during the interview, the clinician A. Uses direct questioning B. Explains behavior/brain interaction theory C. Takes notes conscientiously D. Provides empathetic response.

____ 10. For a patient who is overinclusive or rambling, the clinician A. Asks the patient to tell his story B. Uses direction and redirection C. Increases the amount of eye contact D. Interviews the person accompanying the patient ____ 11. In a biopsychosocial assessment, which of the following questions might be used to assess the social

domain? Did any medical conditions precipitate the psychiatric symptoms? Did the patient have any childhood attentional problems or school phobia? Has the patient ever attempted suicide or harmed himself? Have the symptoms affected the patient’s social and work functioning?

A. B. C. D.

Chapter 4: Communicating, Interviewing and Assessing Answer Section MULTIPLE CHOICE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

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A B B C A B A C D B D

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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

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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

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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

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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

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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

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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 5: Case Formulation and Diagnosis, Differential Diagnoses and Developing a Biopsychosocial Plan of Care Answer Section MULTIPLE CHOICE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS: ANS:

A B A D C A C D A A

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Chapter 6: Psychopharmacotherapy Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1. The tricyclic antidepressant class of medications can be characterized by all of the following

properties except A. Long half-life B. Inexpensive cost C. Safety in overdose D. High rate of side effects ____

2. Antidepressants are used with caution in which of the following disorders? A. Major depression with atypical features B. Adjustment disorder with depression C. Bipolar disorders D. Dysthymia

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3. Which class of antidepressants has the most anticholinergic side effects? A. Monoamine oxidase inhibitors (MAOIs) B. Selective serotonin reuptake inhibitors (SSRIs) C. Tricyclic antidepressants (TCAs) D. Serotonin norepinephrine reuptake inhibitors (SNRIs)

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4. TCAs are effective in treatment of depression because they block A. Reuptake of serotonin and dopamine B. Reuptake of serotonin and norepinephrine C. Action of monoamine oxidase enzyme D. Histamine receptors

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5. In treating a patient with depression for whom you want to increase norepinephrine, which of the

following antidepressants would you choose because it specifically increases levels of norepinephrine? A. Reboxetine (Vestra) B. Fluoxetine (Prozac) C. Phenelzine (Nardil) D. Venlafaxine (Effexor) ____

6. A patient with bipolar disorder who has been on lithium for 3 months has a blood lithium level of 0.3

mEq/L when tested. You anticipate A. Improvement of manic symptoms B. No improvement of manic symptoms C. Improvement of depressive symptoms D. Symptoms of moderate lithium toxicity ...