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1. Collette is a 23-year-old female who presented for emergency care with her mother because her behavior has become increasingly erratic and caused her to lose her job. Her mother reports that she had never done anything like this in the past, but about 3 months ago, her boyfriend of 3 years broke up with her, and Collette began to express unrealistic beliefs that her boyfriend wanted to drive her crazy and hurt her. A gentleman trying to hail a taxi accidentally bumped into her this morning, and she started screaming that her ex-boyfriend had hired the man to throw her into the street under a car. Collette is on a 2-week suspension from her job as a restaurant server because she was combative to a customer—she accused him of colluding with her ex-boyfriend to get her fired. After this morning’s incident, her mother was so worried she brought her to the emergency room. Her appearance is disheveled, she is clearly hyperalert and is crying that her boyfriend must have converted her mother to work against her. Head imaging, screening lab, and a toxicology screen are negative. A leading differential for Collette is:
Bipolar disorder
Acute psychotic episode
Schizophreniform disorder
Post-traumatic stress disorder
1 points
1. Jake and Laurie are a young married couple who have been referred to mental health counseling because Jake is having disturbing sleep events. Laurie reports that on more than one occasion she has awakened to find Jake having what appears to be a panic attack, but he doesn’t seem to realize it. When he finally wakes up, he is confused and doesn’t really understand what happened, although he does have a sense of intense fear. This has happened twice in the last 2 weeks, and the last time Laurie heard him screaming. Jake is now a bit afraid to go to sleep and as a result does not feel well the next day. The PMHNP recognizes that sleep terrors in adults:
Are often associated with trauma or psychiatric problems
Represent a disorder of REM sleep
May be a symptom of temporal lobe epilepsy
Is treated with a cycle of sleep deprivation
1 points
1. Jack is a 27-year-old male who has a history of paranoid schizophrenia that first became apparent approximately 10 years ago. He developed paranoid delusions and eventually decompensated to the point that he required inpatient stabilization. At the time, he was started on conventional antipsychotics, but due to intolerable adverse effects he was switched to haloperidol. It worked well, but whenever he stopped taking it, symptoms would recur. After several hospitalizations, he was stabilized. The neurophysiologic theory of schizophrenia suggests that Jack’s symptoms were a result of:
Increased dopamine activity in the mesolimbic pathway
Increased dopamine activity in the mesocortical pathway
Increased glutamate in the prefrontal cortex
Increased glutamate in the hippocampus
1 points
1. Johanne is a 22-year-old female who is being treated for narcolepsy. She is attempting to implement a regimen of forced daytime naps in an effort to manage her condition without pharmacotherapy as she is generally averse to taking medications. While following Johanne, the PMHNP should be alert to signs and symptoms of:
1 points
1. The PMHNP is asked to prepare a presentation for non-nursing health care workers in a local long-term care facility on the various causes of cognitive impairment in the elderly. A case presentation approach is used to reinforce principles of identifying delirium, which needs to be reported to the patient’s attending provider right away. The case should emphasize which of the following features as being closely correlated with delirium?
Perceptual disturbances
Rapid onset
Abnormal sleep patterns

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