Question 1
0 out of 1 points
Sally is a 54-year-old female who presents for care at the urging of her employer.
She says that she doesn’t think she needs to be there, but the manager of her
division at work strongly
...
Question 1
0 out of 1 points
Sally is a 54-year-old female who presents for care at the urging of her employer.
She says that she doesn’t think she needs to be there, but the manager of her
division at work strongly suggested that she make an appointment. She is the
evening shift manager in the accounting department of a major online sales
organization. Her role requires meticulous accountability of a complex system of
production statistics, and she has done this exceedingly well for years. She has
been a valued employee, and her work is above reproach. A few months ago, the
company adopted a new software program that required a complete revamping of
Sally’s department. She has not adapted well, and her resulting anxiety is almost
prohibitive of functioning in her role. During her interview, Sally is very somber
and serious, and is clearly having difficulty with this change. She is distraught over
the potential of not being able to do her job well and meet her immediate
supervisor’s expectations. Recognizing the likely diagnosis, the PMHNP knows that
Sally is likely to respond best to:
Selected
Answer:
[None Given]
Answers: Pharmacotherapy with
clonazepam
Free-association, nondirective
therapy
Interpersonal therapy
Serotonergic agents
Response
Feedback
:
(b) is the correct answer. These patients often recognize that there is a
problem and will do well with this form of therapy, although it is a long
and complex process. Clonazepam and serotonergic agents are
effective with obsessive-compulsive disorder, but their utility with
obsessive-compulsive personality disorder is less clear. Interpersonal
therapy is not among the therapeutic modalities with any
demonstrated success with this personality disorder.
● Question 2
1 out of 1 points
Becci is a 31-year-old female who presents to the PMHNP for evaluation after
being referred by her friend who is a patient of the practice. She describes a
relatively acute, recent onset of panic attacks. Becci says that “out of the blue”
her heart starts to race, her mouth gets dry, she gets shaky, and feels like she
cannot get her breath. She is afraid because her friend has panic disorder and
Becci knows that before her friend got treatment, she basically would not leave
the house in case an attack happened. The PMHNP recognizes that the immediate
priority in assessment for Becci is:
Selected
Answer: A thorough physical examination
Answers:
A thorough physical examination
A family history of mental health
disease
A urine drug screen
An assessment for phobic
disorder
Response
Feedback
:
(a) is the correct answer. While these are elements of a panic attack,
there are a variety of organic conditions that can cause these
symptoms. Becci needs a physical examination and appropriate
laboratory assessment to rule out physiologic causes of her symptoms,
such as thyroid disease. The remaining elements above will all be part
of the mental health assessment once physical health is determined.
● Question 3
0 out of 1 points
Mrs. Bowen is a 33-year-old female who presents as a new patient requesting
medication for depression. She reports a long history of mood disorders on and off
going back to adolescence. She is very articulate in describing her history and
reports that neither sertraline nor fluoxetine “worked for her.” She was unable to
remember the dose or how long she took the medication. With respect to
considering Mrs. Bowen’s medication history, the PMHNP knows that:
Selected
Answer: Some forms of recurrent depression are best managed with
nonpharmacologic strategies
Answers: An SNRI will likely be the most appropriate choice if
pharmacotherapy is indicated for this episode
This may be an inaccurate characterization, as depressed patients
tend to overemphasize negatives
In some circumstances patients will purposefully mischaracterize the
efficacy of medications they feel were ineffective
Some forms of recurrent depression are best managed with
nonpharmacologic strategies
Respons
e
Feedback
:
(b) is the correct answer. A common mistake among clinicians is to
accept the depressed patient’s self-report of medication accuracy.
Depressed patients frequently overemphasize the negative and
minimize the positive and may genuinely have a misimpression of their
medications effectiveness; similarly, unrealistic expectations may skew
their impression of medication response. An SNRI may ultimately be
the most appropriate choice, but the PMHNP should not base this
primarily on the patient’s self-report of SSRI response. This should not
be perceived as a purposeful mischaracterization – the patients are not
usually trying to misrepresent thing; they are reporting their genuine
impression. Finally, recurrent depressions spanning decades will most
likely require pharmacotherapy along with some form of
nonpharmacologic intervention for best outcomes.
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