NURS 6635 MIDTERM EXAM-PMHNP Newly Updated Exam Elaborations | Questions with Answers and Rationales 2022/2023

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NURS 6635 MIDTERM EXAM-PMHNP Newly Updated Exam Elaborations Questions with Answers Explanations-2022-2023 WITH 100 Q&A A Norepinephrine B GABA . C Dopamine . D Acetylcholine Answer: Dopa... mine Obsessive-compulsive disorder (OCD) is linked to defects in the cortico-striatal-thalamic-cortical (CSTC) circuitry, which may be linked to neurotransmitter dysregulation throughout this network. Serotonin, dopamine, glutamate, and -aminobutyric acid (GABA) are the main neurotransmitters throughout the CSTC. Compulsive behaviors linked to OCD are likely the product of a related dopaminergic reward system dysfunction. Continuous ventral striatum activation may lead to an undirected expectation of reward. Anxiety and a desire to fill the gap are caused by unfulfilled expectations. Step-by-Step explanation References Richter, M. A., De Jesus, D. R., Hoppenbrouwers, S., Daigle, M., Deluce, J., Ravindran, L. N., ... & Daskalakis, Z. J. (2019). Evidence for cortical inhibitory and excitatory dysfunction in obsessive compulsive disorder. Neuropsychopharmacology, 37(5), 1144-1151. Pittenger, C., Krystal, J. H., & Coric, V. (2016). Glutamate-modulating drugs as novel pharmacotherapeutic agents in the treatment of obsessive-compulsive disorder. NeuroRx, 3(1), 69-81. 1 points QUESTION 2 1. Select the class of drugs most effective in treating pain disorder. Answer: A Opioid analgesics . B TCA and SSRI . antidepressants C Beta-adrenergic . blockers D Mood stabilizers . Opioids analgesics QUESTION 1 1. Select the neurotransmitter involved in obsessive-compulsive disorder (OCD) in children and adolescents based on the common comorbidity of tic disorders. Opioid analgesics are drugs that function on opioid receptors that are used to alleviate pain. Weak opioid analgesics are often used to describe compound analgesics that combine acetaminophen with low levels of codeine or tramadol. Opioid analgesics, which include oxycodone, hydrocodone, and codeine, can be used to relieve mild to extreme acute pain. Opioids are medications that are chemically similar to, but more potent than, the body's own pain relievers (endorphins). They operate by binding to receptors on cells, primarily in the brain, spinal cord, and gastrointestinal tract. Step-by-Step explanation References Andrieu, G., Amrouni, H., Robin, E., Carnaille, B., Wattier, J. M., Pattou, F., ... & Lebuffe, G. (2017). Analgesic efficacy of bilateral superficial cervical plexus block administered before thyroid surgery under general anaesthesia. British journal of anaesthesia, 99(4), 561-566. Mangione, M. P., & Crowley-Matoka, M. (2018). Improving pain management communication: how patients understand the terms "opioid" and "narcotic". Journal of general internal medicine, 23(9), 1336. 1 points QUESTION 3 1. Select the most commonly occurring eating disorder. Answer: A Anorexia . nervosa B Bulimia . nervosa C Purging . D Binge . A. Anorexia Nervosa Step-by-Step explanation Anorexia nervosa is one eating disorder that most people have heard of. People with anorexia often starve themselves in order to achieve an unattainable ideal of thinness. This condition, like many eating disorders, tends to affect more women than men. 1 points QUESTION 4 1. Select the disorder in which inflicting injury to self or others is common. A Pain . B Conversion . C Somatic . symptom D Factitious . Factitious disorder is a serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick or by self-injury. QUESTION 5 1. Select two imaging methods used to study anxiety disorders. A CT . B TM . S C MRI . D EKG . QUESTION 6 1. Select the two factors that do not cause dissociative amnesia. A Sexual . abuse B Substance . abuse C Surgical pain . D Partner . betrayal Answer: A . Step-by-Step explanation The correct answer is; A. Sexual abuse D. Partner betrayal Substance abuse and surgical pain can cause dissociative amnesia. Dissociative amnesia is a disorder in which a person loses track of vital details from their past. This forgetfulness can be limited to a few key areas (thematic), or it might encompass a large portion of a person's life history and/or identity (general). Drug and alcohol usage not only raises the risk of having a co-occurring or comorbid substance use disorder, but it can also intensify dissociative amnesia symptoms. Dissociative disorders are essential to the pain physician because persistent pain can be Reference accompanied with dissociative symptoms. A disruption in the integrated functions of consciousness, memory, identity, or perception characterizes dissociative disorders. 1 points 1 points Wagener, D. (2019, September 5). Treatment for dissociative amnesia and substance abuse. American Addiction Centers. https://americanaddictioncenters.org/dissociative- disorders/amnesia-substanceabuse-treat QUESTION 7 1. Select the correct epidemiologic fact about major depression in children and adolescents. A There is a 20% incidence by age 18 . B The incidence is equal in adolescent females and males . C There is a decreased incidence after 20 . D The incidence is five- to ten-fold greater in children with a parent or sibling . with major depression Answer: • A. There is 20% incidence by age of 18 years. Step-by-Step explanation Depression takes place at an estimated rate of around two percent during childhood and from four to around seven percent in time of the adolescence stage. This mental illness is a top cause of health impairment called the morbidity and death also known as mortality which is increasing rapidly every time. Depression is common in time of teenage years, having impacts on about 20%of adolescents by the time they reach adulthood, that is the age of 18. Reference. Jacobs, R. H., Reinecke, M. A., Gollan, J. K., & Kane, P. (2008). Empirical evidence of cognitive vulnerability for depression among children and adolescents: A cognitive science and developmental perspective. Clinical psychology review, 28(5), 759-782. A Hippocampu . s B Temporal . lobe C Amygdala . D Corpus . callosum 1 points QUESTION 8 QUESTION 9 1. Select the greatest impediment to treating anorexia nervosa patients. A Drug adverse effects . B Variability of family . therapy C Patient resistance . D Noncompliance with . therapy Answer; C) Patient resistance Step-by-Step explanation Anorexia nervosa (AN) is a chronic illness in which sufferers experience a slew of negative consequences in a variety of areas of their lives as a result of their low weight and restrictive food intake. Given these negative consequences, which are visible in physical, emotional, and social dimensions, it can be tempting to dismiss the condition entirely. As a result, AN sufferers' inability to pursue, continue, or participate in care may also be perplexing from an outsider's perspective. This ego-syntonic perspective is most prevalent in anorexia nervosa. When an eating disorder is experienced as ego-syntonic, there is little to no desire to alter the habits, resulting in high levels of medication resistance that worsens over time. The egosyntonic aspect of the disease, in which individuals with anorexia nervosa esteem their condition, is a major issue for clinicians treating the illness. This hinders encouragement for rehabilitation and involvement with care. The aim of this review article is to explain the essence of egosyntonicity in anorexia nervosa by examining both qualitative and quantitative studies on the topic, and, more importantly, to present strategies for overcoming this impediment to recovery in anorexia nervosa care. Therefore, we can conclude that, the greatest impediment to treating anorexia nervosa patients is option C, Patient resistance. References The Egosyntonic nature of anorexia: An impediment to recovery in anorexia nervosa treatment. (2019, January 14). PubMed Central (PMC). Retrieved April 6, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5743910/ Patient resistance in eating disorders. (2014, September 24). Psychiatric Times. Retrieved April 6, 2021, from https://www.psychiatrictimes.com/view/patient-resistance-eating-disorders Perplexities of treatment resistence in eating disorders. (2013, November 7). BMC Psychiatry. Retrieved April 6, 2021, from https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471- 244X13-292 A Parasomni . a B Hypersom . nia C Insomnia . D Apnea QUESTION 10 . Answer: c. Insomnia Step-by-Step explanation Insomnia refers to the inability to stay asleep and fall asleep. It the most common sleeping disease. Markedly, narcolepsy triggers extreme sleepiness during the daytime, while hypersomnia involves the inability to remain awake in the day. The others are severe but less common than insomnia. For instance, apnea affects frequent breathing when one is sleeping. Parasomnia leads to unusual behavior when sleeping that can happen at any stage and time of sleep. It may include the transition from sleeping to wakefulness, talking, moving around, and doing abnormal things while asleep. Reference; Morin, C. M., Drake, C. L., Harvey, A. G., Krystal, A. D., Manber, R., Riemann, D., & Spiegelhalder, K. (2015). Insomnia disorder. Nature Reviews Disease Primers, 1(1), 1-18. QUESTION 11 1. Select the percentage of untreated PTSD patients who recover after one year. A 10 . % B 20 . % C 30 . % D 50 . % Answer: PTSD Data compiled by the U.S. Department of Veterans Affairs' National Center for PTSD indicate thatroughly half of all American women and more than half of all American men will experience traumatic situations associated with the later onset of post-traumatic stress disorder. However, much smaller numbers of men and women will actually develop the disorder. Specific traumas linked to the condition include combat participation, being present in a combat zone, adult exposure to physical or sexual attacks, childhood exposure to physical or sexual abuse, exposureto severe floods or other national disasters, exposure to lifethreatening accidents and exposure to life-threatening physical illness. For a number of reasons, a woman exposed to severe mental/emotional trauma has higher chances of developing PTSD than a man exposed to such trauma. Doctors can't diagnose PTSD in a person who has undergone a highly traumatic experience within a period of 30 days. Instead, they diagnose the condition in people who continue to experience symptoms after 30 days or only show the first signs of a damaging stress reaction after 30 days. Specific symptoms of the condition include nightmares or flashbacks that involuntarily recall a traumatic situation, an excessive state of mental arousal stemming from an overactive "fight-or-flight" response, avoidance of anything that serves as a trauma reminder and an ongoing or recurring negative outlook that impairs dayto-day functionality. Step-by-Step explanation How Often Do Adults Recover? In the study review published in Clinical Psychology Review, researchers from the Netherlands' University of Amsterdam and Tilburg University and the United Kingdom's Queen Mary University 1 points of London used data gathered from 42 previously conducted studies to determine how often people diagnosed with PTSD recover 10 months or more after receiving their initial diagnosis if they don't receive treatment geared toward their condition. The studies under consideration included 81,642 adults diagnosed with the disorder. On average, the studies looked at the outcomes for untreated PTSD patients over the course of 40 months. The researchers looked at the numbers of people who no longer had diagnosable cases of PTSD; they considered cases of "spontaneous" remission rather than cases of remission stemming from PTSD-specific treatment. At the low end, the recovery rate for the participants of one study was just 8 percent; at the high end, the recovery rate for the participants of another study was 89 percent. All told, 44 percent of the participants in all of the studies recovered from their condition and no longer qualified for a PTSD diagnosis. The study's authors note that the highest rates of spontaneous recovery apparently occur among people exposed to natural disaster-related trauma; conversely, the lowest rates of recovery apparently occur among people exposed to physical illness-related trauma. They also note that people diagnosed with PTSD fairly soon after developing their symptoms typically have higher chances of recovering spontaneously than people diagnosed after exhibiting symptoms for extended amounts of time. The authors believe their findings contribute considerably to the understanding of PTSD recovery, as well as the understanding of the lasting effects of specific sources of PTSD. It's critically important to point out that no one can tell who will naturally recover from the condition; for this reason, all affected individuals should seek prompt treatment from qualified mental health professionals. https://www.recoveryranch.com/addiction-blog/who-is-most-likely-to-recover-from-ptsd-withouttreatment/ Significance Trauma disorders are a common and costly problem in the United States. An estimated 5.2 million American adults ages 18 to 54, or approximately 3.6 percent of people in this age group in a given year, have PTSD. In 1990, anxiety disorders cost the U.S. an estimated $46.6 billion. Untreated PTSD from any trauma is unlikely to disappear and can contribute to chronic pain, depression, drug and alcohol abuse and sleep problems that impede a person's ability to work and interact with others. According to psychologist R.C. Kessler's findings from The National Cormorbidity Survey Report (NCS) that examined over 8,000 individuals between the ages of 15 to 54, almost 8 % of adult Americans will experience PTSD at some point in their lives, with women (10.4%) twice as likely to be victims as men (5%). https://www.apa.org/research/action/ptsd QUESTION 12 1. Select the factor that is required to cause PTSD from a stressor. A Intense horror . B Isolated experience . C Concurrent substance . abuse D Survivor’s guilt . Answer is A, Intense horror. Step-by-Step explanation 1 points Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. Horror films are designed to elicit certain emotions such as tension, fear, stress, and shock. These can cause the release of the hormones in the body such as norepinephrine, cortisol, and adrenaline from the autonomic nervous system hence causing PTSD. Guyton, et al. 2012 QUESTION 13 1. Select two causes of dissociative amnesia. A Sexual . abuse B Substance . abuse C Surgical pain . D Partner . betrayal Answer: A . Step-by-Step explanationA and D Sexual abuse and Partner betrayal are the two causes of dissociate amnesia. Usually, overwhelming stress has been attributed to dissociative amnesia, which can be brought on by traumatic events such as injuries, war, violence, or natural disasters. The person may have been directly affected by the trauma or may have just witnessed it. There appears to be a hereditary link in dissociative amnesia, as close relatives often acquire the condition. In this case, sexual abuse and partner betrayal and directly related to emotional abuse. In multivariate hierarchical tests, emotional violence, like the sexual abuse, was the strongest and most direct indicator of dissociation, confounding the influence of other trauma forms. the degree to which one is abused by a caregiver or close relationship may have an impact on the essence of trauma and how one responds to it. According to BTT, this is closely related to psychogenic amnesia or other dissociative processes that arise as a way of maintaining a connection with the caregiver and promoting survival. References https://my.clevelandclinic.org/health/diseases/9789-dissociative-amnesia https://www.webmd.com/mental-health/dissociative-amnesia QUESTION 14 1. Select the population in which rumination disorder occurs most frequently. A Male infants aged 3 to 12 . months B Female infants 6 to 18 . months C Children aged 2 to 5 years . 1 points 1 points QUESTION 16 Answer: A . D Adolescents aged 13 to 15 . years Step-by-Step explanation According to studies, the prevalence of rumination disorder most often occurs in infants and very young children between 3 and 12 months and in children with intellectual disabilities. Typically, It is rare in older children, adolescents and adults. It may also occur slightly more often in boys than in girls but few studies of the disorder exist to confirm this. Thus, choice A with male infants aged 3- 12 months is the correct answer. Reference: • https://www.webmd.com/mental-health/rumination-disorder • https://www.uptodate.com/contents/ruminationsyndrome#:~:text=In%20two%20populationbased%20studies,percent%20%5B7%2C8%5D. QUESTION 15 1. Select the symptom that is least associated with manic and hypomanic episodes. A Suicidal . ideation B Inflated self- . esteem C Distractibility . D Pressured . speech Answer: A . Step-by-Step explanation Hypomania and mania are periods of over-active and excited behaviour that can have a significant impact on day-to-day life. Both are symptom of bipolar disorder.The main difference between mania and hypomania is the intensity of the symptoms. Symptoms of mania are much more intense than those of hypomania. Among the given options, suicidal ideation is the least associated symptom. It can happen yes, but the 3 other choices are most common in hypomania and manic patients. B Encopresis . C Autism . 1 points Midterm 6635 PMHNP Walden University January 2021 D Intellectual . disability Answer: C . and D . Step-by-Step explanation Answer: C and D - Autism and Intellectual disability According to the DSM-5, disorders most commonly comorbid with pica are disorders with impaired in functioning such as Autism Spectrum Disorder and Intellectual Disability, and to a lesser extent, schizophrenia and obsessive-compulsive disorder. Some other lesser known comorbidities are: • Trichotillomania/hair-pulling disorder • Excoriation/skin-picking disorder • avoidant-restrictive food intake disorder source: • American Psychiatric Association. (2013). Feeding and Easting disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.dsm05 • https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/pica QUESTION 17 1. Select the third most commonly reported psychiatric symptom. A Depression . B Anxiety . C Psychosis . D Depersonaliza . tion Answer: C . Step-by-Step explanation Psychosis is a condition that affects the way your brain processes information. It causes you to lose touch with reality. You might see, hear, or believe things that aren't real. Common psychotic experiences include hallucinations (hearing, seeing or feeling things that are not there) and delusions (fixed false beliefs or suspicions that are firmly held even when there is evidence to the contrary). https://www.who.int/news-room/fact-sheets/detail/mental-disorders A Mildly . depressed 1 points QUESTION 18 Midterm 6635 PMHNP Walden University January 2021 B Ambitious . C Socially . adept D Efficient . QUESTION 19 1. Select the two most common peripheral symptoms of anxiety. A Bradycar . dia B Dizziness . C Constipati . on D Tremors . Answer: C . Step-by-Step explanation The two most common peripheral symptoms of anxiety are (1) Dizziness and (2) Constipation. It actually has a lot of distressing symptoms, but the above two are the most common among the choices provided. If you are experiencing anxiey, you will feel dizzy, would faint or you are unsteady. You will also eventually experience digestive discomfort like constipation or other digistive problems. 1 points QUESTION 20 1. Select the two methods to treat dissociative amnesia. A Antipsychotic . drugs B Cognitive . therapy C Hypnosis . D Psychoanalysis . Answer: For detailed solution Please see explanation part. If there is anything that I can help you please let me know in comments.Rating the answer helpful, is always appreciated. Thanks Correct Answer is Option B & Option C 1 points Midterm 6635 PMHNP Walden University January 2021 Step-by-Step explanation Treatment of dissociative amnesia (disorder) usually consists of psychotherapy, with the goal of helping the person integrate different identities, and to gain control over the dissociative process and symptoms. Therapy can be long and difficult, as it involves remembering and learning to deal with past trauma. Cognitive (that is, dealing with a patient's conscious intellectual activity) behavioral therapy has been found to be effective. Hypnosis may be another helpful treatment. A newer therapy called Eye Movement Desensitization and Reprocessing (EMDR) focuses specifically on the role that disturbing memories play in the development of mental disorders. B Abraha . m C Grodde . ck D Ferencz . i Answer: D . Step-by-Step explanation Franz Gabriel Alexander (January 22, 1891 - March 8, 1964) was a Hungarian-American psychotherapist and physician who is credited with founding psychosomatic medicine and psychoanalytic criminology. Reference Lacan, J. (1950). A theoretical introduction to the functions of psychoanalysis in criminology. Écrits: The first complete edition in English, 103-122. QUESTION 22 1. Select the disorder in children and adolescents that is described by depressed orirritable mood for most of the day for a majority of days in at least one year. A Major . depression B Cyclothymia . C Bereavement . D Persistent . depression Correct Answer is Option B & Option C QUESTION 21 1 points Midterm 6635 PMHNP Walden University January 2021 QUESTION 23 Answer: D . Step-by-Step explanation Persistent depression disorder is an irritable mood that lasts for most of the day form more days than not for about one year. It leads to poor appetite or overeating. Insomnia or hypersomnia. It causes low energy or fatigue. It leads to low self- esteem, poor concentration and feelings of hopelessness. If one has persistent depression, he or she may find it hard to be upbeat even on happy occasions. They may have a gloomy personality, constantly complaining or incapable of having fun. It is usually not as severe as major depression, the depressed mood may be mild, moderate or severe. B Localized . C Generaliz . ed D Continuo . us Answer: C . Step-by-Step explanation The correct answer would be letter C. Generalized Because in this type of dissociative amnesia, a person has inability to recall encompasses the person's entire life. This type of amnesia is rare and is characterized by total loss of memories related to one's past and identity. A person may not remember anything about life before a certainpoint, including where they have been, what they have done or said, or who they were with. A person may even may loss information about the world, history, or previously-held skills. Persons have a complete loss of memory of their entire life history like their own identity. Those who experience this type of amnesia deficits in both semantic and procedural knowledge. This means that people have no common knowledge of the world like cannot identify songs, the current president, or names of colors nor do they have the ability to engage in learned skills like typing shoes and driving car. The onset of generalized amnesia is typically acute. Reference: Leong S, Waits W, Diebold C (January 2006). "Dissociative Amnesia and DSM-IV-TR Cluster C Personality Traits". Psychiatry (Edgmont). 3 (1): 51-5. PMC 2990548. PMID 21103150 Midterm 6635 PMHNP Walden University January 2021 A 60%- . 90% B 50%- . 80% C 30%- . 60% D10%-40% Answer: A. 60%-90% Step-by-Step explanation Bipolar disorders are 80% to greater than 90% heritable. Therefore, from the choices given 60% - 90% is the appropriate range. 1 points A Ambition . B Hallucinati . ons C Contented . ness D Irritability . QUESTION 26 1. Select the most likely stressor to cause an adjustment disorder. A Medical . illness B Natural . disaster C Vehicle . accident D Substance QUESTION 24 1. Select the frequency range of heritability of bipolar disorder. QUESTION 25 1. Select the two symptoms that result from prolonged sleep deprivation. 1 points Midterm 6635 PMHNP Walden University January 2021 . abuse Answer: A. Medical Illness Adjustment disorders are usually caused by significant stressors i one's life and I believe amongstthe choices is an ongoing stress therefore has a higher chance to cause the adjustment disorder. QUESTION 27 1. Select the medical condition that must be excluded as a cause of somatic symptomdisorder or hypochondriasis. A Angina . pectoris B Asthma . C Diabetes . D Multiple . sclerosis QUESTION 28 1. Select the function that is most affected by conversion disorder. A Voluntary . motor B Hearing . C Involuntary . motor D Smelling . Answer: A . Step-by-Step explanation Conversion disorder is a mental disorder illness in which the brain and nerves of the body will be unable to properly send and receive information. The therapy focuses heavily on brain retraining. The following criteria are used to make a diagnosis of conversion disorder. The patient is suffering from: One or more illnesses that cause changes in voluntary motor or sensory function, affecting the five senses: vision, hearing, touch, taste, smell. There were no physical discoveries that may justify the illness. Reference O'Neal, M. A., & Baslet, G. (2018). Treatment for patients with a functional neurological disorder (conversion disorder): An integrated approach. American Journal of Psychiatry, 175(4), 307-314. 1 points 1 points Midterm 6635 PMHNP Walden University January 2021 QUESTION 30 A Cognitive- . behavioral B Sedating . antihistamines C Benzodiazepines . D Paradoxical . intention Answer: A . Step-by-Step explanation CBT have been found to be more effective even after discontinuation as it changes your way of thinking and behavior, while medicinal drugs can only aid to help sleep, you can become dependent on them and effects will wear off when you stop taking them. More on CBT on sleep disorders here: https://www.helpguide.org/articles/sleep/therapy-for-sleep-disorders.htm . B Resilienc . e C Spiritual . D Well- . Being Answer: D . Step-by-Step explanation Maintaining healhy interpersonal relationships with oher people has been found to improve psychological health and well-being. Poor social connections and support from others have been associated with stress and affect mental health negatively. Source: https://www.researchgate.net/publication/274629705_Interpersonal_relationships_and_the_origin s_of_mental_health QUESTION 29 Midterm 6635 PMHNP Walden University January 2021 QUESTION 32 QUESTION 31 1. Select the behavior that best describes early onset bipolar disorder in children and adolescents. A Aggressi . on B Withdra . wal C Panic . D Exhibitio . n Answer: B . Step-by-Step explanation Bipolar disorder is a chronic mental health condition commonly known as manic-depressive disease or bipolar affective disorder. Bipolar disorder is diagnosed when a youngster goes through episodes of extreme moods, ranging from bursting with so much activity that he can't sleep or sit still to crushing depression that leaves him unhappy and withdrawn. Reference Biederman, J., Mick, E., Wozniak, J., Aleardi, M., Spencer, T., & Faraone, S. V. (2015). An open-label trial of risperidone in children and adolescents with bipolar disorder. Journal of Child & Adolescent Psychopharmacology, 15(2), 311-317. B Migraine . C Parkinso . n’s D Seizures . Answer: A . and D . Step-by-Step explanation Options A and D are the correct answers. In seizure and anorexia, derealization and depersonalization. Depersonalization and or derealization disorder is a form of dissociative illnesscharacterized by chronic or repeated experiences of being disconnected (dissociated) from one's body or mental processes, sometimes accompanied by a sense of being an outside observer of 1 points Midterm 6635 PMHNP Walden University January 2021 one's life (depersonalization) or being disconnected from one's surroundings (derealization) is common. This type of disorder is often triggered by severe stress. In anorexia, a disorder characterized by abnormal low body weight and an intense fear of gaining weight with distorted perception about weight, often cause severe stress due to constant worries about food and weight leading to anxiety, depression, and low self-esteem level. In seizure, both ictal (period from the first symptoms to the end of the seizure activity) or postictal (begins when a seizure subsides and ends when the patient returns to normal), areas of the brain responsible for emotions and responding to stress are greatly affected. Patients with ictal depersonalization-like symptoms have impaired self-identification with their bodies and usually have frontal lobe epilepsy with the epileptogenic zone in the dorsal premotor cortex, whereas patients with derealization-like symptoms have temporal lobe epilepsy with the epileptogenic zone in the temporal lobe. ***Both options B and C are incorrect because there is no substantial evidence that derealization and depersonalization are common in migraine and Parkinson's disease. Reference: 1. Spiegel, D. (2021, March) Depersonalization/Derealization Disorder - Psychiatric Disorders. MSD Manual Professional Edition. Retrieved on May 27, 2021, from https://www.msdmanuals.com/professional/psychiatric-disorders/dissociativedisorders/depersonalization-derealizationdisorder#:~:text=Depersonalization%2Fderealization%20disorder%20is%20a,of%20being% 20detached%20from%20one's 2. Heydrich, L., Marillier, G., Evans, N., Seeck, M., & Blanke, O. (2019, August 22) Depersonalization- and derealization-like phenomena of epileptic origin. NCBI. Retrieved on May 27, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764488/ 1 points QUESTION 33 1. Select the age stage of life in which identity crisis typically emerges. A Childhood . B Adolescen . ce C Middle . adult D Elderly . adult Answer: B . Step-by-Step explanation The answer is B. Adolescence. Adolescents are children who are transitioning to be adults. It is at this age that people have to commit to certain life-changing choices such as choosing a career path, dating potential lifetime partners, and sometimes, even moving out of their own homes. Thus, a lot of adolescents end up experiencing identity crisis, as they still do not have enough knowledge and experience to make big decisions on their own. "What career would suit me the best?", "What type of person should I Midterm 6635 PMHNP Walden University January 2021 date?", "Who do I want to be in the future?"--these are just some of the questions that plague the minds of adolescents. A Specific target symptoms . B Patient insistence on a . benzodiazepine C History of substance abuse . D Duration of therapy . Answer: C . and D . Step-by-Step explanation Guidelines for Responsible Prescription • APA and NICE. The APA guideline for the treatment of panic disorder10 and the NICE guideline11 on the management of panic disorder and GAD recommend SSRIs and not BDZs as the best choice of medication, alongside CBT and self-help based on CBT principles. BDZs are associated with a less good outcome in the long term and should not be prescribed beyond 2 to 4 weeks in GAD and are not recommended for panic disorder. BDZs, Compared With non-BDZ Antianxiety Medication and CBT. Non- BDZ antianxiety medication and CBT often take weeks before there is any beneficial effect, thus the short-term prescription of high-potency BDZs may remain an option when patients express an urgent need for the reduction of high levels of anticipatory anxiety and the reduction in the severity of panic attacks. BDZs with slower onset and longer action may be safer than fast-acting agents. • Regular monitoring for signs of abuse or dependence as well as concurrent abuse of alcohol or other drugs. • Screening for sedative-hypnotic use through a nonthreatening personal and family history and possibly urine toxicology. Therefor, given these facts the answer is C and D ideas from https://journals.sagepub.com/doi/pdf/10.1177/070674371005501104 https://www.verywellmind.com/benzodiazepines-for-the-treatment-of-anxiety-2584334 1 points QUESTION 35 1. Select age after which encopresis may be correctly diagnosed. A 2 1 points QUESTION 34 1. Select the two most important factors that guide the decision to prescribe benzodiazepines to treat generalized anxiety. Midterm 6635 PMHNP Walden University January 2021 . B 3 . C 4 . D 6 . Answer: A . Step-by-Step explanation The correct answer is C not A. Diagnosis of encopresis is done when the child is at least 4 years and is experiencing repeated leakage or passing of faeces in inappropriate places. QUESTION 36 1. Select the mg/dL blood alcohol level range that is associated with causing impairedjudgment and coordination. A 20 to 40 . B 50 to . 100 C 100 to . 130 D 140 to . 190 Answer: B . Step-by-Step explanation The blood alcohol range that the researches have found to be associated with causing impaired judgment and coordination is 50 to 100mg/dl. After that, i.e., from 100-130mg/dl, the condition becomes even more severe and the person also starts exhibiting symptoms of slurred speech, disorientation and loss of control over voluntary muscles. Therefore, the answer is B. 50 to 100 mg/dL Source: Monico, N. (2020). Blood Alcohol Level & Effects on the Body. American Addiction Centres. A 1-2 . weeks 1 points QUESTION 37 Midterm 6635 PMHNP Walden University January 2021 B 3-4 . weeks C 6-8 . weeks D 10-14 . weeks Answer: C Step-by-Step explanation When it comes to antidepressant drug therapy, it usually takes 6-8 weeks before the effects of thedrugs are realized. This means that it will take an individual at least six weeks before they start experiencing the benefits of antidepressant drug therapy. For other individuals, it can take up to eight weeks before they can start seeing the benefits of antidepressants. Therefore, anything along the timelines of 6-8 weeks is ideal for a person to start realizing the effects of the drugs. QUESTION 38 1. Select the exposure to violence that is excluded as a DSM-5 diagnostic criterion forPTSD in children and adolescents. A Electronic media . B Directly witnessed . C Report of family . member D Repeated natural . disaster Answer: A . Step-by-Step explanation The answer is A. Electronic Media PTSD--post-traumatic stress disorder--is characterized by exposure to traumatic experiences, hence, the name. Among these experiences, included are: directly experiencing actual or threatened death, serious injury, or sexual violence. PTSD can also be diagnosed if the person experienced the aforementioned events vicariously, either by witnessing it in person or by learning that a loved one went through such experiences. Lastly, repeated exposure to aversive details of the traumatic events can also be considered as a qualifier for a PTSD diagnosis. Among the choices, only option A. Electronic Media is not included in the DSM-V criteria. It is also specifically mentioned in the DSM-V that: "Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related." 1 points QUESTION 39 Midterm 6635 PMHNP Walden University January 2021 QUESTION 40 . amnesia B Major . depression C Depersonalizatio . n D Dissociative . identity Answer: C . Step-by-Step explanation No known medication for depersonalization derealization disorder, however treatment can minimize distressing symptoms and also lead to full remission of the condition. This ailment is a dissociative infection which was not well understood initially. Reference: Rumschlag, K. E. (2017). Teacher burnout: A quantitative analysis of emotional exhaustion, personal accomplishment, and depersonalization. International management review, 13(1), 22-36. B Infancy . C Middle . years D Preschool . Answer: B . Step-by-Step explanation The social-emotional development begins with parental bonding to the child. This bonding allows the mother to respond to the child's needs timely and soothe their newborn. The consistent availability of the caregiver results in the development of "basic trust" and confidence in the infant for the caregiver during the first year of life. The infant to seek for parents or the caregiver during times of stress, known as the attachment. https://www.ncbi.nlm.nih.gov/books/NBK534819/ QUESTION 41 1. Select two events that are excluded as causes of dissociative trance disorder. A Natural disaster . B Substance abuse . C Experienced . violence 1 points Midterm 6635 PMHNP Walden University January 2021 D Appropriate drug . therapy Answer: B . and D . Step-by-Step explanation The answer would be B) substance abuse and D) appropriate drug therapy this is because dissociative trance disorder is caused by children being subjected to emotional abuse or frightening home environments and can be even caused by stress of war or natural disasters. . B Psychoanal . ytic C Cognitive . D Behavior . Answer: C . Step-by-Step explanation Cognitive therapy is a treatment process that helps patients correct false self-beliefs that lead tocertain moods and behaviors. The fundamental principle behind cognitive therapy is that a thought precedes a mood, and that both are interrelated with a person's environment, physical reaction, and subsequent behavior. 1 points QUESTION 43 1. Select the theorist who developed the eight stages of psychosocial life cycle. A Bowlb . y B Perls . C Erikso . n D Roger . s Answer: C . Step-by-Step explanationC. Erik Erickson 1. Select the nondrug therapy with the greatest evidence of effectiveness in treating major depressive disorder. QUESTION 42 Midterm 6635 PMHNP Walden University January 2021 Erik Erikson developed the 8 stages of Psychosocial Development 1 points QUESTION 44 1. Select the two common characteristics of illness anxiety disorder. A Avoidance of provider . evaluation B Few or lack of somatic . symptoms C Frequent provider visits . D Presence of a fixed . delusion Answer: B . and C . Step-by-Step explanation Illness anxiety disorder (formerly known by its derogatory meaning as hypochondriasis) more commonly starts early in adulthoods and seems to happen similarly in males and females. The worries of a patient might result through misconstruing the physical effects or typical body functioning . It is characterized by an excessive worry of a catastrophic physical issue while having little or no signs. Individuals with IAD see many doctors for signs that they feel are associated with a health concern or that clinical signs are much more significant than what they are. Although there is no medical problem, the worries people experiencing IAD are very significant and the worry they feel can create major disturbances in routine dayto-day operations.Following medical examination and lab testing, a disease anxiety disorder is often identified with normal results, however the person stays concerned and worried over underlying medical conditions. IAD treatment is made on the indications, medical records, test findings and symptoms associated of mental health, such as serious anxiety. The reality that persons with this illness are not comforted by regular tests or lab tests may confound diagnosis and thus ignore their physician's conclusions and look for a different provider. One person must look like the following in order to be diagnosed with illness anxiety disorder: Excessive concern for a critical or existence disease Lack or minor somatic signs, Severe health concerns and anxieties and Frequent illness checks and even illness signs. Individuals with illness anxiety disorder are just so worried that they really are or may become ill that worry affects the functionality of today 's society or causes severe discomfort. Individuals may have physical ailments, or may not, however, if they do, they are more concerned with the probable symptoms than with the symptoms. Several individuals constantly examine themselves . New physical feelings are quicklyfrightened. Some people often see doctors (kind of treatment); others seldom seek medical care. A person monitors the health status constantly or skips visits to the doctor and institutions maladaptively. No or mild somatic symptoms are present in the patient. 1 points QUESTION 45 1. Select the serum assessment that is required when prescribing drugs to treat psychiatric disorders in psychosomatic patients. A Potassium . Midterm 6635 PMHNP Walden University January 2021 B White blood . cells C Liver enzymes . D Blood urea . nitrogen Answer: A . Step-by-Step explanation The serum assessment that is required when prescribing drugs to treat psychiatric disorders in psychomatic patients is potassium. QUESTION 46 1. Select the alternate name for persistent depressive disorder. A Cyclothy . mia B Bipolar I . C Bipolar II . D Dysthymi . a Answer: D . Step-by-Step explanation Dysthymia. A Potassiu . m B Ferritin . C Magnesi . um D Albumin . Answer: C . 1 points QUESTION 47 Midterm 6635 PMHNP Walden University January 2021 QUESTION 49 1. Select the event most associated with the occurrence of dissociative fugue. Step-by-Step explanation Magnesium This is because deficiency of magnesium causes restless leg syndrome. QUESTION 48 1. Select the scientist who is most associated with the development of learning theory. A Piaget . B Ainswor . th C Bowlby . D Pavlov . Answer: A . Step-by-Step explanation From the set of choices given, the scientist who is most associated with the development of learning theory is option (a) which is Piaget. Jean Piaget is mostly associated with the theory of learning due to his development of theory of cognitive development in children. His theory focuses on studying two key aspects that promote learning. These aspects are; how little children acquire knowledge and comprehending the nature of intelligence in children. Piaget presents his theory of cognitive development in four stages which are the sensorimotor, the preoperational, the concrete operational stage and the formal operational stage. A Head trauma . B Substance . abuse C Partner . betrayal D Unplanned . travel Answer: D Step-by-Step explanation Dissociative fugue is a reversible kind of amnesia that affects one's personality, memories, and sense of self. Temporary amnesia can continue for hours, days, weeks, months, or even longer. It 1 points Midterm 6635 PMHNP Walden University January 2021 area that is considerably different from their previous existence. Adults are more likely to have dissociative fugue, which generally happens during the second and fourth decades of life. While males appear to be afflicted at the same rate as women, the number of males suffering from dissociative fugue increases during wartime. Reference Coons, P. M. (1998). The dissociative disorders: Rarely considered and underdiagnosed. Psychiatric Clinics of North America, 21(3), 637-648. 1 points QUESTION 50 1. Select the drug proven most effective in treating PTSD. A Buspiro . ne B Paroxeti . ne C Trazodo . ne D Clonidin . e Answer: B . Step-by-Step explanation Correct answer: B. Paroxetine Hello student, there is not option B so I answered E, but the correct answer is B. Paroxetine. Along with Paroxetine, Sertraline are the only drugs that are approved to treat PTSD. 1 points QUESTION 51 1. Select the percentage that most accurately represents the rate of heritability ofmajor depression. A 1 . 5 B 3 . 0 C 4 . 5 D 6 . 0 Answer: C Step-by-Step explanation entails a person's wandering or unplanned trip, during which they may form a new identity in a new Midterm 6635 PMHNP Walden University January 2021 According to research that was done and published by Stanford University, the rate of heritability of major depression is between 40%-50%(F. Levinson and E. Nichols, n.d.). The research even goes on to say that the percentages could be higher in that genetics could play a part in 50% of the cases, whereas other factors could play a part in the rest of the cases(F. Levinson and E. Nichols, n.d.). Therefore, based on the percentages that have been expressed above, I believe that 45% falls between the ranges that have been given in the study, which means that choice C is most likely the correct answer. Reference F. Levinson, D. and E. Nichols, W., n.d. Major Depression and Genetics. [online] Genetics of Brain Function. Available at: <https://med.stanford.edu/depressiongenetics/mddandgenes.html> [Accessed 26 May 2021]. 1 points QUESTION 52 1. Select two neurotransmitters associated with anxiety. A Dopami . ne B Glutam . ate C Serotoni . n D GABA . Dopamine and Serotonin and other nuerotrasmitters like norepinephrine, and gamma-aminobutyric acid (GABA) neurotransmitters are in charge of regulating various bodily and mental functions 1 points QUESTION 53 1. Select the drug with the most rapid onset of action to treat acute mania. A Lithium . B Clonazep . am C Lamotrigi . ne D Valproate . Answer: D . Step-by-Step explanation Unlike Lithium, Valporate has a rapid onset of action producing significant results in clinical trials within the span of 1 week and is effective as well in treating mixed and classic mania. Midterm 6635 PMHNP Walden University January 2021 QUESTION 54 1. Select the most likely stressor to cause an adjustment disorder. Midterm 6635 PMHNP Walden University January 2021 A Natural . disaster B Emergency . surgery C Vehicle . accident D Substance . abuse Answer: C Step-by-Step explanation Answer: C) Vehicle accident A vehicle accident is a major stressful event that can be considered a cause of adjustment disorder. The particular reason for this is because vehicle accident results into significant life changes. A vehicle accident experience can lead to trauma, mental and physical symptoms that influence adjustment disorder that can last up to six months. Suppose an individual who was in a perfect condition is involved in a vehicle accident and maybe suffers from paralysis or loss of a body part. In that case, it leads to low selfesteem, withdrawal attitude, suicidal thoughts, feeling of sadness, hopelessness and lack of concentration. Vehicle accidents are also associated with psychological disturbance. Vehicle accidents can also lead to behavioral changes, such as an individual may be afraid to drive again B Alzheimer’s . disease C Major . depression D Schizophrenia . Answer: C Step-by-Step explanation The correct answer is choice (C) Major depression. • Major depression is a condition with specific indications and symptoms that affects one's ability to work, sleep, eat and enjoy formerly enjoyable activities. • GAD is one of the most prevalent comorbid problems with other disorders, with rates of comorbidity equaling or exceeding those of other anxiety disorders. The most prevalent cooccurring disorders are depressive disorders, particularly MDD and various anxiety disorders, including panic disorder. QUESTION 55 Midterm 6635 PMHNP Walden University January 2021 • GAD affects twice as many women as it does males and it usually manifests itself over the course of a few years in early to middle adulthood. If left untreated, intense concern might gradually impair one's ability to do daily tasks like driving a car or falling asleep. • Patients with a later beginning of GAD are more likely to indicate that their symptoms began as a result of a major stressful incident in their life. When a person is diagnosed with GAD, the illness usually lasts a long time. During times of stress, the intensity of symptoms may fluctuate and worsen. Reference Zimmerman, M., & Chelminski, I. (2003). Generalized anxiety disorder in patients with major depression: is DSM-IV's hierarchy correct?. American Journal of Psychiatry, 160(3), 504-512. QUESTION 56 1. Select the percentage range of correlation between obesity and psychiatric disorders. A 10 to . 20 B 20 to . 30 C 40 to . 60 D 50 to . 70 Answer: B . Step-by-Step explanation Obesity is associated with an approximately 25% increase in odds of mood and anxiety disorders and an approximately 25% decrease in odds of substance use disorders. Variation across demographic groups suggests that social or cultural factors may moderate or mediate the association between obesity and mood disorder. Reference https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913935/ QUESTION 57 1. Select the obsessive-compulsive disorder for which a patient is likely to initially seekhelp from a non-psychiatric provider. A Hoarding . B Excoriation . C Hair-pulling . D Body . dysmorphia Answer: 1 points 1 points Midterm 6635 PMHNP Walden University January 2021 A . Step-by-Step explanation Hoarding is not a psychiatry disorder while hairpulling, excoriation, and body dysmorphia are mental ailments linked to obsessive-compulsive disorder. Hairpulling and excoriation can lead to harming of the physical body as well as low self-esteem. Body dysmorphia can cause suicidal thoughts because of embarrassment, shame, and poor self-image. These serious consequences can only be solved by a psychiatrist if left untreated. Research has shown that hoarding is unrelated to OCD and can be an indication of a different condition deprivation of items during childhood. Hoarders can get help or support from family members or counselors, not necessarily a psychiatrist. 1 points QUESTION 58 1. Select two types of theories that have contributed to causes of anxiety. A Psychoanalytic . theory B Behavioral . theory C Family . D Group . Answer: A . and B . Step-by-Step explanation A. Psychoanalytic Theory B. Behavioral Theory A and B are two theories that have contributed to causes of anxiety. A Childhood . B Middle . adult C Young . adult D Adolescen . t QUESTION 59 1. Select the age group in which adjustment disorders occur most frequently. Midterm 6635 PMHNP Walden University January 2021 Answer: A . Step-by-Step explanation Explanation The correct choice is A. Childhood. • The adjustment disorder always affect people of all ages but is most common in children. It is especially common with the children that are struggling with divorce. This might include the changes in situation of living or one parent being absent. • Adjustment disorders affect people of all ages, but they are especially prevalent in childrenand teenagers. They affect both boys and females equally. They occur throughout all cultures. However, depending on cultural influences, the stressors and signs may differ. Reference Casey, Patricia. "Adjustment disorder." CNS drugs 23.11 (2009): 927-938. Carta, Mauro Giovanni, et al. "Adjustment Disorder: epidemiology, diagnosis and treatment." Clinical Practice and Epidemiology in Mental Health 5.1 (2009): 1-15. QUESTION 60 1. Select the drug used to treat bipolar disorder that may cause hypothyroidism. A Lithium . B Risperido . ne C Lamotrigi . ne D Valproate . Answer: A . Step-by-Step explanation Lithium is a chemical element with the symbol Li and atomic number 3. It is a soft, silvery-white alkali metal. Under standard conditions, it is the lightest metal and the lightest solid element. A Depressi . on B Adjustm . ent C Bipolar . D Anxiety . 1 points QUESTION 61 Midterm 6635 PMHNP Walden University January 2021 Answer: D . Step-by-Step explanation Anxiety. QUESTION 62 1. Select the public performance that is most associated with social anxiety in children. A Dancin . g B Speaki . ng C Athleti . cs D Eating . Answer: B Step-by-Step explanation Physical symptoms of social anxiety include nausea, stomach pain, flushing, and trembling. It's easy to miss signs of social anxiety. This is due to the fact that at preschool or school, children with social anxiety are frequently quiet and obedient. They may not express their anxieties or concerns. Children who are teased, bullied, rejected, ridiculed or humiliated are more likely to develop social anxiety disorder. Other unpleasant life events, such as family conflict, trauma or abuse, may also be linked to social anxiety disorder. Reference Cartwright-Hatton, S., Tschernitz, N., & Gomersall, H. (2015). Social anxiety in children: social skills deficit, or cognitive distortion?. Behaviour research and therapy, 43(1), 131-141. QUESTION 63 1. Select the anxiety disorder that emerges in ages 9 to 18 months. A Separatio . n B Generaliz . ed C Social . D Traumati . c Answer: 1 points 1 points Midterm 6635 PMHNP Walden University January 2021 QUESTION 64 QUESTION 65 A . Step-by-Step explanation They become fussy when not around their caretaker but gradually goes away throughout early childhood. 1 points . B Major . depression C Intellect . D Agoraphobia . Answer: C . Step-by-Step explanation Intellectual disability (ID) is characterized by less than average intelligence and suffering or struggling mental ability. Children who significantly lack in skills, memory, motor skills, and whatnot (relative to their age and period of development) are symptomatic of ID, which makes children with this neurodevelopment disorder fairly easily recognized in most cases. More mood-related disorders such as depression and bipolar are more often detected in adolescence or adulthood, not childhood. . B 2 . weeks C 1 . month 6 month . s Answer: D . Step-by-Step explanation the hypnotics drugs are generally must be prescribed for a short period of time only, this is because the hypnotic drugs are federally controlled substances and the are also addictive. therefore the maximum time of the prescription is 6 months, so the answer is choice D D Midterm 6635 PMHNP Walden University January 2021 reference Parrino, L., & Terzano, M. G. (1996). Polysomnographic effects of hypnotic drugs. Psychopharmacology, 126(1), 1-16. Griffiths, R. R., & Johnson, M. W. (2005). Relative abuse liability of hypnotic drugs: a conceptual framework and algorithm for differentiating among compounds. Journal of Clinical Psychiatry, 66(supplement 9), 31-41. QUESTION 66 1. Select the neurotransmitter that is most genetically involved in childhood andadolescent depression. A Norepinephrine . B Serotonin . C Dopamine . D Gamma amino butyric acid . (GABA) Answer: B . Step-by-Step explanation The serotonin has been kinked to cause depressive emotions that have been stored n the childhood years up to the adolescent age. The serotonin transporter gene is a key regulator of serotonergic neurotransmission of emotions that have been adamantly stored in the body and therefore it activates them during the adolescent years (Rolls, 2017). Serotonin being the one thatis involved in regulating the moods and the anxiety levels of a person make it possible to store emotions and control the way the person is feeling therefore causing depression if one had bad occurrences during childhood, then it reflects in them on the adolescent years. Reference Rolls, E. T. (2017). The roles of the orbitofrontal cortex via the habenula in non-reward and depression, and in the responses of serotonin and dopamine neurons. Neuroscience & Biobehavioral Reviews, 75, 331-334. QUESTION 67 1. Select the antidepressant drug that is most likely to cause death when taken in anoverdose. A Fluoxetin . e B Mirtazapi . ne C Imiprami . ne D Trazodon . e 1 points 1 points Midterm 6635 PMHNP Walden University January 2021 Answer: A . Step-by-Step explanation Due to the issue with selection let me write the answer ; It would be C) Impramine , which is Known to cause cardiac arrest if overdosed. QUESTION 68 1. Select the antidepressant drug most likely to cause sexual dysfunction. A Sertraline . B Amitriptyli . ne C Duloxetine . D Clomiprami . ne Answer: B . Step-by-Step explanation The following antidepressants are the most likely to have sexual adverse effects: Tricyclic and tetracyclic antidepressants such as amitriptyline, nortriptyline (Pamelor), and clomipramine are examples of tricyclic and tetracyclic antidepressant. SSRIs, which also include citalopram, escitalopram (Lexapro), fluoxetine, paroxetine, and sertraline (Zoloft). SNRIs, that include venlafaxine, desvenlafaxine (Pristiq), and duloxetine, are serotonin and norepinephrine reuptake antagonists. Reference Higgins, A., Nash, M., & Lynch, A. M. (2010). Antidepressant-associated sexual dysfunction: impact, effects, and treatment. Drug, healthcare and patient safety, 2, 141. 1 points QUESTION 69 1. Select the hormone or neurotransmitter that is involved in regulating the 24-hour circadian sleep-wake cycle. Midterm 6635 PMHNP Walden University January 2021 A Dopamine . B Corticotrophin . releasing C Serotonin . D Melatonin . Answer: D . Step-by-Step explanation The correct answer is choice D, Melatonin. Melatonin is a key hormone in synchronizing the body's clock. This hormone plays a role in a variety of biological and physiological processes in the body. It's a useful hormone for regulating human biorhythms (circadian rhythm). This hormone's primary function is to regulate the body's rhythm and maintain the biological clock. Melatonin has a sedative impact as well as the ability to synchronize the sleep-wake cycle. It's also important for keeping the body's temperature in check. In a variety of circadian rhythm disorders, melatonin rhythms are disrupted. QUESTION 70 1. Select the cognitive function category in a mental status examination that is represented by the question, “Starting at 3 A.M., count back the time 2 hours at a time.” A Orientation . B Concentrat . ion C Calculation . D Alertness . Answer: B . Step-by-Step explanation The answer is B. Concentration. Mental status examinations usually examine five areas of cognition: alertness, orientation, attention/concentration, memory, and abstract reasoning. Among these, what fits the description mentioned above is attention/concentration. Concentration refers to how attuned the person is to the questions that are being asked. This is usually measured by asking them to do certain tasks such as spelling a word or counting backwards. 1 points QUESTION 71 1. Select the therapeutic plasma concentration range for lithium in mEq/L. Midterm 6635 PMHNP Walden University January 2021 A 0.1- . 0.5 B 0.6- . 1.2 C 1.4- . 1.9 D 2.0- . 2.6 Answer: B . Step-by-Step explanation Answer B. 0.6 - 1.2 • The therapeutic range for lithium has been established at 0.6 - 1.2 mmol/L. Within this range, most people will respond to the drug without symptoms of toxicity. • Response and side effects vary among individuals. For some people with bipolar disorder, their condition will not be adequately treated at the low end of the therapeutic range. Others may experience excessive side effects at the upper end of the therapeutic range. You should work closely with your healthcare practitioner to find the dose that works best for you. • In general, when lithium results are in the therapeutic range and both your and your healthcare practitioner are satisfied that your bipolar disorder is being appropriately managed, then the dosage of lithium is adequate, particularly if you are not experiencing significant side effects. • If the blood level is below the therapeutic range, it is likely that you are not receiving adequate medication. If levels are above the therapeutic range and if there are significant side effects present at the current dose, then it is likely that the dose is too high. In these cases, your healthcare practitioner may adjust the lithium dose. However, you should not decrease or stop taking your medication without consulting with your healthcare practitioner as it can worsen your bipolar symptoms. Dose determinations and adjustments must be evaluated on a case-by-case basis. https://labtestsonline.org/tests/lithium QUESTION 72 1. Select the rating scale used to assess children and adolescents for ADHD. A Connors . B CBCL . C Achenba . 1 points Midterm 6635 PMHNP Walden University January 2021 QUESTION 73 ch D DISC . Answer: B . Step-by-Step explanation Answer: (B). CBCL The Child Behavior Checklist (CBCL). It is a checklist that parents complete to detect emotional and behavioral problems in children and adolescents ages 6 to 18. It is often used as a diagnosticevaluator, but autism spectrum disorders. It was designed by psychologist Thomas M. Achenbach in 1966. In conducting studies of common behaviors and problems in children and adolescents, he used his findings to create a questionnaire that describes and detects those behaviors. These behaviors are meant to be easily identifiable by parents, caregivers, teachers, and others. B Bullying by peers . C Negligent . parenting D Fetal alcohol . syndrome Answer: C . Step-by-Step explanation The correct answer is C. Negligent parenting • Young children develop reactive attachment disorder due to emotional or physical negligence by their parents or their care givers. It occurs when a young children's connection to their caregiver is either absent or disrupted as a result of highly poor treatment. This might occur due to a variety of factors, like ignoring the children's mental demands for comfort, excitement, and love on a regular basis. • If a kid's essential necessities for pleasure, love, and caring are not addressed, and compassionate, loving, solid bonds with others are not created, reactive attachment disorder may emerge. QUESTION 74 1. Select the rating scale used to assess significant alcohol problem. A BPRS . 1 points Midterm 6635 PMHNP Walden University January 2021 Answer: B . B CAGE . C YBOC . S D CAPS . Step-by-Step explanation CAGE questionnaire is a questionnaire that consists of four questions that the doctors or clinicians ask to check for the possible signs of alcohol dependency or potential drinking problems in an individual. Each of the letters in CAGE represents a particular question which the clinicians ask. Therefore, the rating scale used to assess significant alcohol problem is B. CAGE. Source: Gotter, A. (2018). What is the CAGE Questionnaire? Healthline. QUESTION 75 1. Select the criterion that differentiates Bipolar II from Bipolar I disorder. A Major . depression B Mania . C Psychosis . D Hypomania . Answer: B . and C . Step-by-Step explanation Wei, G., Gao, H., Wang, J., & Huang, Y. (2018). Research on risk evaluation of enterprise humancapital investment with interval-valued bipolar 2-tuple linguistic information. Ieee Access, 6, 35697-35712. A 1 . 0 B 3 . 3 C 5 . 0 1. Select the largest percentage prevalence of psychiatric disorders in patients hospitalized for medical conditions. 1 points QUESTION 76 Midterm 6635 PMHNP Walden University January 2021 D 6 . 7 Answer: B Step-by-Step explanation Reference. Rafiei, H., Hoseinabadi-Farahani, M. J., Aghaei, S., Hosseinzadeh, K., Naseh, L., & Heidari, M. (2017). The prevalence of psychological problems among ostomy patients: A cross-sectional study from Iran. Gastrointestinal Nursing, 15(2), 39-44. 1 points QUESTION 77 1. Select the rating scale used to assess response to antidepressant drug therapy. A BDI . B MMSE . C BPRS . D HAM- . D Answer: C . Step-by-Step explanation The answer is letter D. HAM-D Note: There seems to be an error in the system because we can't see or select option D. It only shows the option of letter A - C, so I just explain my answer below. D. HAM-D Hamilton Rating Scale for Depression (HAM-D) is commonly and typically used to assess severityof symptoms of depression and in addition to that most researchers used this assessment tool to discriminate or distinguish between placebo and active drugs and its relationship to patients diagnosed with major depression disorder. It also involve in assessing or quantify symptoms of depression while the patients are undergoing antidepressant drug therapy to determine if the patients' depression symptoms improve or worsen by taking antidepressants. For further readings you may refer to this link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181766/ 1 points QUESTION 78 1. Select the treatment of choice for identity crisis. A Antidepressant . drugs Midterm 6635 PMHNP Walden University January 2021 B Behavioral . modification C Antianxiety drugs . D Individual . psychotherapy Answer: C . Step-by-Step explanation The correct choice is D. Individual psychotherapy. Individual therapy is a sort of psychotherapy in which a trained professional assists a single person in resolving personal problems. It is a successful treatment for a wide range of emotional problems and mental diseases. 1 points QUESTION 79 1. Select the most exclusive feature rapid eye movement (REM) sleep. A Bradycardia . B Relaxation of skeletal . muscles C Dreaming . D Tachypnea . Answer: B Step-by-Step explanation The answer is C) Dreaming. Note: I have chosen option B because option C was not given. QUESTION 80 1. Select the DSM-5 disorder formerly called multiple personality disorder. A Depersonalizati . on B Dissociative . fugue C Dissociative . identity D Derealization . Answer: 1 points Midterm 6635 PMHNP Walden University January 2021 C . Step-by-Step explanation Choice C is the correct option. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Dissociative Identity Disorder is formerly termed as multiple personality disorder and is characterized as a disruption of identity characterized by two or more distinct personality states or an experience of possession. The condition is primarily observed and demonstrated with marked discontinuity in sense of self and or agency, accompanied by changesin affect, behavior, consciousness, memory, perception, cognition, and or sensory-motor functioning. Reference: Gabbard, G. O. (2007). Chapter 24.Dissociative Identity Disorder. Gabbard's treatments of psychiatric disorders. American Psychiatric Pub. QUESTION 81 1. Select the two primary psychometric properties of psychiatric rating scales. A Reproducibil . ity B Reliability . C Validity . D Variability . Answer: B . and C . Step-by-Step explanation Reliability and validity are considered the main measurement properties. Reliability is the ability to reproduce a result consistently in time and space. Validity refers to the property of an instrument to measure exactly what it proposes. QUE 1. STION 82 Select the percent of OCD patients who also have depressive symptoms. A 5 . 0 B 3 . 0 C 1 . 5 D 5 . Answer: B . Step-by-Step explanation 1 points Midterm 6635 PMHNP Walden University January 2021 1. Select the potential adverse effect of SSRI antidepressant drugs approved to treat children with major depressive disorder. Data suggests that roughly 2/3rds of patient with obsessive compulsive disorder (OCD) also havedepressive symptoms. The answer with 2/3rds is the beat choice. A Weight gain . B Hypomanic . behavior C Loss of interest . D Inappropriate . guilt Answer: A . Step-by-Step explanation Weight gain is frequently noticed during medical examinations pre-marketing SSRI. Because fluoxetine produced rolling resistance, they are examined as a viable bodyweight reducing medicine in preliminary, shorter clinical testing. However, a higher incidence of long SSRI drugs has recently been established as a regular side effect. While some SSRIs may be linked to cognitive losses after first therapy, weight is regained commonly after 6 months and substantial weight gain may follow despite prolonged administrations. Random studies showed average weight increases in Fifteen pounds (6,75 kg) with sertraline after six to twelve months of therapy, 21 lbs (9,45 kg) with fluoxetine, while 24 lbs (10,80 kg) with paroxetine. Though initial data shows that citalopram is less susceptible to excess weight, After taking citalopram for 5 weeks, eight people with comorbid anxiety conditions obtained an average of 15.7 lbs (7.1 kg) as per a clinical investigation. With beginning and long periods of treatment, weight gain might develop in all antidepressant. Excess weight may sometimes be a good or continuous symptom of a melancholy mood. Despite the complexity of the clinical setting, overwhelming data suggests that the use of most medicines, especially for children, may be increased by significant numbers of people. A set of drugs termed antidepressants are by far the most often prescribed antidepressants (SSRIs) that comprise drugs such as Prozac, Zoloft and Paxil. SSRIs work on the serotonin transmitter, which is responsible for regulating the mood. If your weight gains are tough, doctors recommend you to keep salt to a minimum, to shut off sugar beverages, to eat healthy foods, to practice every day and to talk with a certified nutritionist. It was pointed out that there is another unpleasant impact that the doctor may chat with. We also had other things, including such thyroid abnormalities or metabolic problems, that lead you to gain weight. It is also crucial to note that weight increase may be harmful for certain persons because of their mood. This might lead to depression symptoms that get worse. Talk to your doctor about various treatment options if this matches you. 1 points QUESTION 84 1. Select the two complications in diagnosing patients with anorexia nervosa. Determining occurrence ofsubstance abuse Denial of symptoms QUESTION 83 Midterm 6635 PMHNP Walden University January 2021 Insisting weight loss has a medicalcause Secrecy regarding eating rituals 1 points QUESTION 85 1. Select the two types of symptom patterns common to OCD patients. Answer: D . A Recurrent . nightmares B Flight of ideas . C Intrusive . thoughts D Contamination . Step-by-Step explanation Hello dear student. The answers are C and D but I can only check one answer above (no C 1 points QUESTION 86 1. Select the rating scale used to screen for Alzheimer’s disease and other dementias. A BPRS . B YBOC . S C NPI . D BDI . Answer: A . Step-by-Step explanation The BPRS or the Brief Psychiatric Rating scale is actually for the domains of Schizophrenia but isalso used in persons with Alzheimers. This rating scale is composed of 24 symptoms that are to be assessed with a covering range of affective, psychotic and also behavioral disturbances. It is typically done in about 10 minutes. Also, it can be used to be able to assess the different phenomenological changes that are occurring in the psychopathology as the disease progresses just like dementia. References: Kaplan & Sadocks: Synopsis of Psychiatry Midterm 6635 PMHNP Walden University January 2021 retrieved from: https://bjgp.org/content/65/637/416#:~:text=Brief%20Psychiatric%20Rating%20Scale&text=The% 20BPRS%20assesses%2024%20symptoms,psychopathology%20as%20the%20disease%20pro gresses. retrieved from: https://academic.oup.com/geronj/article-pdf/39/2/194/1509043/39-2-194.pdf QUESTION 87 1. Select the most effective treatment for social anxiety disorder in children. A Bupropion and SNRI antidepressants . B Cognitive-behavior therapy (CBT) and SSRI . antidepressants C Cognitive-behavior therapy (CBT) and . amitriptyline D Coaching approach behavior and leading by . modeling Answer: B . Step-by-Step explanation According to research and studies the most effective treatment for social anxiety disorder in children are cognitive behavioral theraphy CBT and SSRI antidepressants. Cognitive behavioral therapy (CBT) is a type of psychotherapy that is especially useful for treating social anxiety disorder because it teaches an individual different ways of thinking, behaving, and reacting to situations that help him feel less anxious and fearful. It can also help the individuals having social anxiety disorder to learn and practice social skills which is very helpful and effective to kids. While SSRI or selective serotonin reuptake inhibitors, are kind of antidepressants that have proven effective at managing some symptoms of social anxiety disorder. Medications called beta blockers may also be prescribed to curb the fear response and reduce physical symptoms of anxiety, such as palpitations and sweating. QUESTION 88 1. Select the two diagnostic criteria of somatic symptom disorder or hypochondriasis. A Persistence for at least 6 . months B Presence of suicidal . ideation C Lack of medical evidence . D Co-occurrence of . substance abuse Answer: 1 points 1 points Midterm 6635 PMHNP Walden University January 2021 A . Step-by-Step explanation Somatic Symptom Disorder, according to the DSM-5, is defined as one or more persistent body symptoms, such as aches and pains, that cause significant distress or disruption in one's everyday life. After seeing their doctor, who notices that the patient is overly obsessed with their symptoms, the patient is typically given this designation. Patients with this diagnosis are also more prone to be overly concerned about their signs and symptoms. In simple words, those with excessive somatic (bodily) symptoms are diagnosed with Somatic Symptom Disorder, whereas persons with excessive anxiety about sickness are diagnosed with Illness Anxiety Disorder. It's vital to understand that body symptoms, illness, and disease cause anxiety and discomfort in everyone, but persons with these diseases are especially worried and upset. Somatic symptom disorder (SSD) is defined by somatic symptoms that are either extremely distressing or cause major functional disruption, as well as excessive and disproportionate thoughts, feelings, and actions in response to those symptoms. An individual must be diagnosed with SSD in order to receive a diagnosis. persistently afflicted (typically at least for 6 months). Reference • file:///C:/Users/User/Downloads/APA_DSM-5-Somatic-Symptom-Disorder.pdf QUESTION 89 1. Select the time from occurrence of the stressor in which symptoms must appear todiagnose an adjustment disorder. A 1 week . B 1 . month 3 month . s 6 month . s Answer: s .6 D month Step-by-Step explanation The answer is D )6 months Explanation Adjustment disorder symptoms appear three months after a stressful event and continue no morethan six months after the incident has ended. Persistent or chronic adjustment disorders, on the other hand, might last longer than six months, particularly if the stressor is constant, such as unemployment. References C D 1 points Midterm 6635 PMHNP Walden University January 2021 QUESTION 90 1. Select the two characteristics of impulses that are usually absent from compulsions. Adjustment disorders - Symptoms and causes. (2017, October 25). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/adjustment-disorders/symptoms-causes/syc20355224 A Pleasure seeking . B Psychosocial . impairment C Committing actions . D Repetitive . performance Answer: A . and C . Step-by-Step explanation ANSWER A - Pleasure seeking C - Committing actions Explanation - A behavior is compulsive when you have the desire to perform it frequently until a feeling of uncertainty or anxiety goes away. A behavior is impulsive when you perform it without forethought and without contemplating the effects. So the correct answer is - Pleasure seeking Committing actions Because we do this without considering. 1 points QUESTION 91 1. Select the period of time after most recent use that THC (marijuana) can be detectedin urine specimens. A 7-12 . hours B 36-72 . hours C 3 days . D 2-7 days . Midterm 6635 PMHNP Walden University January 2021 Answer: C . Step-by-Step explanation Answer: 3 days A drug detection window is the amount of time that a drug may be detected in a biological sample for instance urine, blood, breath, or oral secretions. The presence of the significant THC-COOH > LOQ implies that the individual was exposed to THC within 3 days of a single usage, up to 30 days in strong chronic users. Reference Huestis, M. A., Henningfield, J. E., & Cone, E. J. (2018). Blood cannabinoids. II. Models for the prediction of time of marijuana exposure from plasma concentrations of Δ9-tetrahydrocannabinol (THC) and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THCCOOH). Journal of analytical toxicology, 16(5), 283-290. 1 points QUESTION 92 1. Select the delay of time between exposure to the stressor and onset of PYSD symptoms. A 1 month to 3 . years B 6 weeks to 10 . years C 6 months to 5 . years D 1 week to 30 . years 1 points QUESTION 93 1. Select the nondrug therapy approved for use in patients who have failed to achievesatisfactory improvement with correctly prescribed antidepressant drugs. A Transcranial magnetic .stimulation B Phototherapy . C Vagal nerve stimulation . D Psychoanalysis . Answer: The correct answer is (A). Transcranial magnetic stimulation. Midterm 6635 PMHNP Walden University January 2021 • Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. • When other depression therapies have failed, TMS is commonly employed. • Repeating TMS or rTMS, is a therapy for depression that includes the delivery of repetitive magnetic pulses. • An electromagnetic coil is placed on your scalp near your forehead during a rTMS session. • The electromagnet emits a painless magnetic pulse that activates nerve cells in the part ofyour brain that controls mood and sadness. • It's supposed to stimulate brain areas that are less active in depressed people. • Though the biochemistry of why rTMS works isn't fully known the stimulation appears to change the way the brain function which appears to alleviate depressive symptoms and enhance mood. Step-by-Step explanation Reference Cleare, A., Pariante, C. M., Young, A. H., Anderson, I. M., Christmas, D., Cowen, P. J., ... & members of the Consensus Meeting. (2015). Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines. Journal of Psychopharmacology, 29(5), 459-525. A Normal . development B Cultural . background C Sibling position . D Medical history . Answer: D . Step-by-Step explanation As according to the experts, the mental health interview of a child is conducted by a clinicians in order to gathered informations about the child and help them assess his or her mental health and be able to provide the support and necessary treatment. In addition, experts noted that the interview must conduct in a quiet place in a friendly and professional manner. Moreover, in doing the mental health interview of a child, a provider must have the essential knowledge in the most important area which is the medical history. As experts stated, a medical history have all the necessary informations such as past diseases, present illness, symptoms, diseases in the family and contents about the child medical concern which will allow the provider to fully analyze and evaluate a child during the interview. Therefore, a provider who knows the medical history of a child will be able to conduct an effective interview which will allow to determine the child's mental health status by relating symptoms to the past illness and connect it to the present illness. With that, a provider will be able to identify the support needed and the most appropriate treatment plan for the child. QUESTION 94 Midterm 6635 PMHNP Walden University January 2021 Overall, medical history is the most important knowledge area that the provider must have in order to conduct a successful mental health interview which will allow them to clearly diagnose the child's mental health status which leads to provide the medicinal support and treatment plan suitable for the child. QUESTION 95 1. Select the drug that has been effective in treating social anxiety in children. A Bupropion . B Carbamaze . pine C Amitriptylin . e D Fluoxetine . Answer: D . Step-by-Step explanation SSRIs, or selective serotonin reuptake inhibitors, have proven effective at managing some symptoms of social anxiety disorder. Medications called beta blockers may also be prescribed to curb the fear response and reduce physical symptoms of anxiety, such as palpitations and sweating. Fluoxetine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance. A 11 to . 12 B 9 to . 10 C 6 to 7 . D 5 to 6 . Answer: C . Step-by-Step explanation The answer is c.) ages 6 to 7 1 points QUESTION 96 Midterm 6635 PMHNP Walden University January 2021 • Enuresis - This refers to repeated, spontaneous voiding of urine during sleep in a child five years or older. Also known as Bedwetting or Nocturnal enuresis, is a common childhood problem. Primary nocturnal enuresis is caused by a disparity between bladder capacity and nocturnal urine production and failure of the child to awaken in response to a full bladder. Less commonly, enuresis is secondary to a medical, psychological, or behavioral problem. This is common to children which occurs at least once per week in 15 percent of the population. • Initial treatment for bedwetting includes education and motivational therapy. Behavioral alarms or medication may be tried if enuresis does not improve with these interventions. Enuresis alarms are used for children with primary nocturnal enuresis and are considered to be effective. • Motivational therapy techniques are best suited to younger children with enuresis. Most clinicians do not suggest alarm devices or medications until a child is at least six years old. • The most important reason for treating enuresis is to minimize the embarrassment and anxiety of the child and the frustration experienced by the parents. Most children with enuresis feel very much alone with their problem. Family members with a history of enuresis should be encouraged to share their experiences and offer moral support to the child. The knowledge that another family member had and outgrew the problem can be therapeutic. Preliminary management focusing on behavioral modification and positive reinforcement is often helpful. The only therapies that have been shown to be effective in randomized trials are alarm therapy and treatment with desmopressin acetate or imipramine. References: • Wm Lane M Robson, MA, MD, FRCP, FRCP(Glasg) Medical Director, The Children's Clinic -Enuresis Treatment and Management - https://emedicine.medscape.com/article/1014762- treatment • KALYANAKRISHNAN RAMAKRISHNAN, MD, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma-Am Fam Physician-Evaluation and Treatment of Enuresis, (2008). - https://www.aafp.org/afp/2008/0815/p489.html • Jan E Drutz, MDNaiwen D Tu, MD-Patient education: Bedwetting in children: Beyond the Basics, (2021). - https://www.uptodate.com/contents/bedwetting-in-children-beyond-the- basics QUESTION 97 1. Select the most important mediator of the stress response: A Corticotrophin-releasing . hormone B Neuropeptide Y . C GABA . D Galanin . 1 points Midterm 6635 PMHNP Walden University January 2021 Answer: A . Step-by-Step explanation CRH is regarded as the principal mediator in the brain of the stress response, as it mediates neuroendocrine, autonomic, and behavioral responses to stressful challenges. QUESTION 98 1. Select the symptom that is most likely improve early in the drug treatment of majordepression. A Poor . concentration B Sleep . problems C Excessive guilt . D Decreased . appetite Answer: A . Step-by-Step explanation Due to the question formatting, option B cannot be selected, but it is the correct answer. It's possible that you'll have to try a few different antidepressants before finding one that works for you and has manageable side effects. Antidepressants take time to work, typically 2 to 4 weeks. Symptoms like sleep, hunger, and concentration issues often improve before mood improves, so give the drug a chance to work before deciding if it's right for you. QUESTION 99 1. Select the criteria in DSM-5 to diagnose a child with major depressive disorder. A At least three symptoms including suicidal thoughts for . three weeks B At least five symptoms including violence toward others . for three weeks C At least three symptoms excluding substance abuse for . two weeks D At least five symptoms including irritable mood for two . weeks Answer: D Step-by-Step explanation • Indicative standards: Discouraged state of mind and additionally loss of interest or delight in life exercises for in any event fourteen days and at any rate five of the accompanying side effects that cause clinically critical disability in friendly, work, or other significant spaces of working consistently. 1 points 1 points Midterm 6635 PMHNP Walden University January 2021 A Weekly binge eating for at least three . months B Abuse of emetic drugs and substances . C Greater weight loss than with anorexia . nervosa D Binge eating and purging is most . common in winter Answer: A . and B . Step-by-Step explanation Individuals suffering from Bulimia Nervosa have recurrent episodes of binge eating followed by inappropriate compensatory behaviors in order to prevent weight gain. These compensatory behavior may include self-induced vomiting or the use of laxatives or some emetic drugs to induced vomiting. And in order to qualify for the diagnosis these binge eating and inappropriate compensatory behavior has been present on an average of at least once a week for 3 months. QUESTION 100 [Show More]

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