Category: Nursing

Sherman Tremaine SOAP note

Case Study

HPI: The session begins with Dr. Moore meeting Sherman Tremaine, a male avatar patient, who was born on November 3rd, 1968. Sherman appears well-dressed but avoids eye contact and fidgets during the session. He indicates that the current date is March 18th, either a Wednesday or Thursday, in Dr. Moore’s office. Sherman mentions his reason for the session, stating his sister compelled him to seek help after their mother’s death, claiming people outside were bothering him. Leaning with a subtle tilt, he gestures toward phantom silhouettes casting glances through the window, asserting they’ve been deployed by governmental bodies to observe him and unjustly inflate his tax liabilities. Sherman reports experiencing auditory and visual hallucinations of these people for weeks, alongside delusions of persecution. He mentions hearing loud voices that disrupt his sleep and believes they tamper with his food. Despite locking his food away, he feels paranoid about contamination. Sherman discloses his substance use, including heavy smoking and occasional alcohol consumption, influenced by his sister’s purchases. He denies cocaine use but admits to past marijuana use, emphasizing he dislikes medication due to adverse effects, citing risperidone’s side effect of gynecomastia. He brings up his father’s past with paranoid schizophrenia and his mother’s struggles with anxiety. Sherman denies suicidal ideation or self-harm history, although he acknowledges prior hospitalizations in his twenties. He takes metformin for diabetes but questions the diagnosis’s validity. Sherman discloses familial dynamics, expressing distrust towards his sister and alleging government conspiracy. Despite these concerns, he maintains a casual demeanor and denies a criminal history, except for frequent calls to 911 about perceived threats.

 

Introduction – Sherman Tremaine Soap note

Schizophrenia spectrum, as well as other psychotic disorders, are characterized by hallucinations, delusions, disorganized behaviors, and negative symptoms. Schizophrenia emerges in late adulthood and is marked with psychotic episodes. These conditions alter an individual daily life and affect their relationship, self-care, and work. In the provided case study, Sherman presents with psychotic symptoms, visual and auditory hallucinations, paranoid ideation as well as persecutory delusions. He has a family history of paranoid schizophrenia and has a history of hospitalization, heavy cigarette smoking, occasional alcohol use, and marijuana use that calls for the differentiation of psychotic disorders from substance induced conditions. Therefore, this case study ensures accurate assessment and collaborative treatment to manage symptoms and promote good quality of life.

Patient information:

Name: S.T

Date of Birth: 1968

Subjective:

CC
(chief complaint):

People outside are bothering me, and my sister has compelled me to seek help.

HPI
:

The onset
: A few weeks ago is when the symptoms started.

The course:
Persistent symptoms since onset.

Duration:
Symptoms lasted for some weeks.

Characteristics:
               Hallucinations: He has visual and auditory hallucinations. He mentions hearing loud voices that disrupt his sleep and people observing him through the window.               Delusions: He believes that people have been deployed by the government bodies to observe him and inflate tax liabilities. He also believes his food is being tampered with.Aggravating factor: Not mentioned.Relieving factor: Not mentioned.Associated symptoms: sleep disruptions due to voices.Substance use: heavy smoking, alcohol consumption, as well as past marijuana use.He dislikes medication because of side effects, like risperidone, because it causes gynecomastia.              
Substance Current Use:
He accepts heavy smoking, occasional alcohol consumption, and past marijuana use, but he denies cocaine use.

Medical History:
He had prior hospitalization in his twenties and was diagnosed with diabetes, which he questions the validity of the diagnosis.

Current Medications
: Metformin.

Allergies
: No allergy reported.

Reproductive Hx
: It is not provided.

BUY A CUSTOM SOAP NOTE HERE

ROS
:

GENERAL: He denies fever, weakness, fatigue or weight loss.

HEENT: Eyes: He denies visual loss, double vision, or blurred vision. Ear, Nose and Throat: There is no hearing loss, congestion, sneezing or sore throat.

SKIN: Denies any itching or rash.

CARDIOVASCULAR: Denies no chest pain, edema or palpitations.

RESPIRATORY: Denies no shortness of breath, sputum or cough.

GASTROINTESTINAL: He denies anorexia, nausea, vomiting, and diarrhea.

GENITOURINARY: He denies urgency, burning on urination and hesitancy.

NEUROLOGICAL: He denies headache, numbness, dizziness and seizures.

MUSCULOSKELETAL: he denies muscle pain, back pain, joint stiffness and pain.

HEMATOLOGIC: no bleeding, bruising or bleeding.

LYMPHATICS: No enlarged lymph nodes.

ENDOCRINOLOGIC: Denies heat and cold intolerance and sweating.

Objective:

Diagnostic results
:

Complete Blood count (CBC): CBC is done to assess for infection, anemia and hematologic diseases that manifest psychiatric symptoms (Juchnowicz et al., 2023). These tests include the hematocrit, platelet, white blood cell, red blood, and hemoglobin count that help rule out the condition.

Toxicology: This is done to identify the substances that could worsen or trigger psychotic symptoms, like cocaine, marijuana, and alcohol, as well as other drugs. For individuals with acute psychotic symptoms, it is advisable to do toxicology screening to rule out if it’s induced by substance use (Fiorentini et al., 2021). This is done by blood tests and urine to detect substances like marijuana, alcohol, cocaine and prescription drugs Sherman Tremaine Soap note.

Imaging studies, the MRI or CT scan: Through imaging studies, brain abnormalities like lesions, tumors and brain atrophy occur because psychotic symptoms are ruled out (Dabiri et al., 2022). Imaging studies are recommended for patients with a new onset of psychosis if neurological signs are present.

Positive and Negative Syndrome Scale (PANSS)

Its components are the positive scale, negative scale, and general psychopathology scale. Positive scale measures for delusions, hallucinations as well as conceptual disorganization. Negative scale measures for emotional withdrawal, blunted effort, and poor rapport. Psychopathology scale measures guilt, feelings as well as concentration difficulties. It is used to assess for severe symptoms of schizophrenia. Positive symptoms include hallucinations rated at 6, persecutory delusions rated 6, and conceptual disorganization rated 4. The negative symptoms include emotional withdrawal, rated 4; blunted affect rated five and poor rapport, rated 3. They are consistent with paranoid schizophrenia

Assessment:

Mental Status Examination:

Appearance
: he was well dressed, fidgeted and avoided eye contact.

Behavior:
he was fidgeting, had subtle leaning tilt and had gestures towards imaginary things.

Mood:
He was paranoid but distrustful.

Affect:
He maintains a casual demeanor.

Thought process:
He had persecutory delusions and delusional thinking.

Perception:
He had visual as well as auditory hallucinations.

Insight:
He has poor insight because of delusions and irrationality.

Judgment:
He has impaired judgment, evidenced by frequent calls to 911.

Diagnostic Impression:

Paranoid schizophrenia (F20.0)
:
He has visual and auditory hallucinations, persecutory delusions, and some symptoms that characterize paranoid schizophrenia. He believes that there are people deployed by the government to observe him as well as his tax liabilities inflation. He also has an auditory hallucination where there are sounds that disrupt his sleep. He sees phantom silhouettes outside. His father has schizophrenia, and it supports the diagnosis. Using the DSM-5-TR criteria, he meets the criteria because of symptoms like hallucinations and delusions as well as altered functioning like disrupted sleep and paranoia (Palit, 2023). He also has distrust issues and denies the history of psychiatric history.

Substance-Induced Psychotic
Disorder (F19. 959)
:
This disorder involves delusions and hallucinations that are directly related to substance. He has a history of heavy smoking, past marijuana use, and occasional alcohol consumption. DSM-5-TR criteria for diagnosis require that the symptoms are present during the withdrawal and intoxication periods (Gicas et al., 2022). They must be present during as well as soon after withdrawal or intoxication of the substances used. Despite his history of substance use, his symptoms are present even without the heavy usage of the substances, thus ruling out the diagnosis.

Delusional Disorder (F22):
This is the persecutory type that is characterized by delusions taking longer than one month without symptoms like impaired functions outside delusions impacts, disorganized and delusions. He believes that people are observing him fit this disorder. DSM-5-TR criteria hold that the hallucinations, if present, are related to the delusion the person is experiencing (González-Rodríguez & Seeman, 2022). In his case, the hallucinations, both auditory and visual, are not related to his delusions.

The primary diagnosis is paranoid schizophrenia.

The rationale for this is that his hallucinations, both auditory and visual, as well as delusions, are characteristics of schizophrenia. Additionally, there is a family history of schizophrenia. They are the pertinent positives for his case, indicating schizophrenia. The absence of current substance use usage, withdrawal or intoxications helps rule out the substance-induced psychotic disorder, while the hallucination’s presence rules out the delusional disorder diagnosis. They are the pertinent negatives. Sherman Tremaine Soap note

Reflections:

After this case review, I come to an agreement with the assessments as well as the diagnostic imprint of Sherman’s paranoid schizophrenia. The diagnosis is supported by his symptoms, which include visual and auditory hallucinations as well as delusions. The case emphasized the need for comprehensive psychiatric assessment, history, symptoms, and diagnostic tests to help in getting the potential diagnosis and differentiating the diagnosis. I have learned that it is important to consider medical factors as well as psychiatric factors during diagnosis formation. I also learned the importance of understanding various causes of psychotic symptoms and helping in giving the correct diagnosis.

What I would do differently is I would explore in-depth the substance use and its relationship with psychotic symptoms exhibited by him. I would try to create rapport with him to improve his trust in people and, in return, be able to obtain information accurate information because he would be truthful when trust is won.

I would ensure informed consent and confidentiality when dealing with him. Also, I would ensure his safety as well as other people’s safety with his history of calls to 911 that could be a result of perceived threats. I would also ensure he understands his condition and the importance of medication to manage symptoms despite the previous side effects of drugs he had used.

The health promotion would involve educating him on the benefits of medication adherence, psychotherapy and lifestyle medication, like quitting smoking and alcohol. Given his diabetes history, regular exercise and a balanced diet are essential for his health. I would educate on the antipsychotic drugs’ side effects because they can affect metabolic factors. The treatment should address the specific needs of the patient. I would involve him in care and be culturally sensitive.

Case Formulation and Treatment Plan:

Psychotherapy

Cognitive Behavioral Therapy(CBT).
This helps reduce paranoia and underscores reality testing. This helps him differentiate realistic from altered perception, and this would reduce his delusions of being watched (Kingdon & Turkington, 2022). This helps decrease the intensity and frequency of delusions.

Supportive therapy:
This is to help him build trust with those around him and enhance his coping skills. It helps improve stress management, offers emotional support, and ensures he gets a sense of security. This is achieved through showing empathy, active listening, and being experienced in rapport creation and trust.

Pharmacologic treatment

Initiation of aripiprazole, an antipsychotic drug. The starting dose is 10 mg OD. It has low metabolic side effects compared to risperidone that he had been prescribed (Preda & Shapiro, 2020). Also, he has a low risk of gynecomastia development that he experienced earlier. Its usage would be monitored for efficacy and side effects like nausea, akathisia, as well as dizziness. For diabetes management, metformin would be continued because he is already on medication. Monitoring of blood sugars would be essential when on medication to ensure it is well controlled. Additionally, to help with sleep disturbances, trazodone 50 mg should be prescribed. It has efficacy in treating insomnia for patients with psychiatric conditions and has no dependence risk associated with its usage (Jaffer et al., 2017).

Non-pharmacologic treatment

He should be enrolled in a smoking cessation program to address his heavy smoking that would affect his health. This program involves support groups, behavioral counseling and medications like bupropion. Also, alcohol consumption should be reduced because it has negative results on mental health. Alcoholics Anonymous support groups could be used to help him quit alcohol use Sherman Tremaine Soap note.

 

References

Dabiri, M., Dehghani Firouzabadi, F., Yang, K., Barker, P. B., Lee, R. R., & Yousem, D. M. (2022). Neuroimaging in schizophrenia: A review article. 
Frontiers in neuroscience
, 
16
, 1042814. https://doi.org/10.3389/fnins.2022.1042814

Fiorentini, A., Cantù, F., Crisanti, C., Cereda, G., Oldani, L., & Brambilla, P. (2021). Substance-induced psychoses: an updated literature review. 
Frontiers in psychiatry
, 
12
, 694863.
https://doi.org/10.3389/fpsyt.2021.694863

Gicas, K. M., Parmar, P. K., Fabiano, G. F., & Mashhadi, F. (2022). Substance-induced psychosis and cognitive functioning: A systematic review. 
Psychiatry Research
, 
308
, 114361.
https://doi.org/10.1016/j.psychres.2021.114361

González-Rodríguez, A., & Seeman, M. V. (2022). Differences between delusional disorder and schizophrenia: A mini narrative review. 
World journal of psychiatry
, 
12
(5), 683.
https://doi.org/10.5498%2Fwjp.v12.i5.683

Jaffer, K. Y., Chang, T., Vanle, B., Dang, J., Steiner, A. J., Loera, N., … & Ishak, W. W. (2017). Trazodone for insomnia: a systematic review. 
Innovations in clinical neuroscience
, 
14
(7-8), 24. Sherman Tremaine Soap note

Juchnowicz, D., Dzikowski, M., Rog, J., Waszkiewicz, N., Karakuła, K. H., Zalewska, A., … & Karakula-Juchnowicz, H. (2023). The usefulness of a complete blood count in the prediction of the first episode of schizophrenia diagnosis and its relationship with oxidative stress. Plos one, 18(10), e0292756. https://doi.org/10.1371/journal.pone.0292756

Kingdon, D. G., & Turkington, D. (2022). 
Cognitive-behavioral therapy of schizophrenia
. Psychology Press.

Palit, S. (2023). The science of paranoid schizophrenia, the science of biomedical research and the visionary future. 
SAR Journal of Psychiatry and Neuroscience
, 
4
(6), 25-26. DOI: 10.36346/sarjpn.2023.v04i06.001

Preda, A., & Shapiro, B. B. (2020). A safety evaluation of aripiprazole in the treatment of schizophrenia. 
Expert opinion on drug safety
, 
19
(12), 1529-1538.
https://doi.org/10.1080/14740338.2020.1832990 
 Sherman Tremaine Soap note

FOCUSED SOAP NOTE FOR SCHIZOPHRENIA SPECTRUM, OTHER PSYCHOTIC, AND MEDICATION-INDUCED MOVEMENT DISORDERS

Focused SOAP Note for Schizophrenia Spectrum Disorders

Subjective:

Chief Complaint (CC):

“I was living, and not bothering anyone, and those people, those people, they just won’t leave me alone.”

History of Present Illness (HPI):

Sherman Tremaine (ST) is a 53-year-old male with a history of schizophrenia who presents for a mental health assessment at the request of a friend. ST reports feeling lonely since his mother’s death three years ago. He claims to have lived a solitary life without causing trouble but believes people constantly watch him from outside his window. ST reports hearing and seeing shadows of these individuals. He expresses paranoid thoughts about the government sending people to monitor him due to what he perceives as excessively high taxes.

ST says he had audio hallucinations from trying to change his senses of sight and sound. His hallucinations include loud metallic noises that keep him awake for days. He watches TV to survive but thinks others outside observe him through the screen. Since these people break into his residence and mess with his food, ST keeps it in the fridge to avoid contamination.

BUY A CUSTOM PAPER  HERE

ST initially claims to drink beer and smoke three cigarettes daily but later admits this is false. He discloses that he stopped using marijuana and began misusing cocaine after his mother’s death. ST denies any history of seizures or blackouts related to substance use. He dislikes psychiatric drugs, including Thorazine, Haldol, Seroquel, and Risperidone, as hazardous. ST denies considering self-harm or harming others.

Past Psychiatric History:

ST reports a history of mental illness, with three psychiatric hospitalizations at age 20. He is currently prescribed medications for his mental illness but is non-compliant due to his beliefs about their harmful nature.

Family Psychiatric History:

ST’s father was in an old state facility for mental illness. Mother allegedly had anxiousness.

Substance Use History:

ST admits to currently smoking three packs of cigarettes per day. He drinks alcohol weekly, with his most recent consumption being the previous day. His sister provides him with a 12-pack of beer weekly during grocery shopping. ST stopped using marijuana three years ago after his mother’s death but began misusing cocaine at that time. He denies any history of seizures or blackouts related to substance use.

Medical History:

ST has a diagnosis of diabetes, for which he takes Metformin regularly.

Current Medications:

Metformin (dosage not specified) for diabetes management

Prescribed but not taking: Thorazine, Haldol, Seroquel, and Risperidone for mental health management

Allergies:

No known allergies

Reproductive History:

ST is unmarried and has no children.

Psychosocial History:

ST is younger than his older sister. Their mother and sister were his primary caregivers. His mother died three years ago. ST lived with his father before moving in alone after his mother’s death.  He believes his sister is attempting to change their living arrangement. ST’s education is limited to the 10th grade, restricting his personal development opportunities. He has no history of legal troubles but has had encounters with law enforcement due to frequent calls about his hallucinations.

Review of Systems (ROS):

General: Denies fever, chills, weight changes, or sweating.

HEENT: Denies eyesight loss, impairment, swallowing issues, sore throat, or nasal blockage.

Skin: Denies markings, rashes, or itching.

Cardiovascular: No cardiac symptoms or palpitations confirmed.

Respiratory: Coughing, breathing difficulty, or sneezing denied.

Gastrointestinal: Refuses nausea, diarrhea, constipation, or vomiting.

Genitourinary: Denies urgency, urination pain, nocturia, or frequency changes.

Neurological: Denies headache, syncope, and localized neurological deficits.

Musculoskeletal: Denies joint and muscle pain and stiffness

Hematologic: Does not report bruises or anemia

Lymphatics: No leg swelling or discomfort, no lymphadenopathy noted.

Endocrinologic: Denies cold/heat intolerance, excess thirst/hunger, or thyroid disorders.

Objective:

Diagnostic Results: All baseline testing, including hormonal functioning tests, came back within normal limits.

Assessment:

Mental Status Examination
: Sherman Tremaine, 53, appears his age. He is calm, alert, and helpful with the examiner. ST is appropriately clothed and groomed. Though oriented to people and places, he is disoriented by his current circumstances. He speaks coherently and at a regular volume. ST smiles appropriately but is anxious. His thought process is coherent and logical, without evidence of thought disorders such as dissociation or derealization. ST strongly denies any sensory disturbances in others despite reporting both auditory and visual hallucinations himself. There are no overt signs of delusions present during the examination. He denies any suicidal or homicidal ideation. ST’s memory and attention appear intact. His judgment and insight are assessed as fair.

Diagnostic Impression:

Primary Diagnosis: Schizophrenia Spectrum Disorder (F20.9)

Differential Diagnoses:

Substance-Induced Psychotic Disorder (F19.959)

Delusional Disorder (F22)

Rationale for Diagnoses

Schizophrenia Spectrum Disorder (F20.9): ST’s presentation strongly aligns with the DSM-5-TR criteria for schizophrenia. He exhibits positive symptoms (auditory and visual hallucinations, paranoid thoughts) and negative symptoms (social withdrawal). The symptoms have persisted for an extended period, causing significant functional impairment. ST’s history of multiple psychiatric hospitalizations in his 20s and ongoing symptomatology support a chronic course of illness characteristic of schizophrenia. FOCUSED SOAP NOTE FOR SCHIZOPHRENIA SPECTRUM, OTHER PSYCHOTIC, AND MEDICATION-INDUCED MOVEMENT DISORDERS

Key supporting evidence includes

Persistent auditory and visual hallucinations

Paranoid thoughts about being watched and monitored

Disorganized thinking (e.g., beliefs about high taxes reaching the sky)

Social withdrawal and functional impairment

Chronic course of illness with onset in early adulthood

Substance-Induced Psychotic Disorder (F19.959): While ST’s cocaine use could potentially induce psychotic symptoms, this diagnosis is considered less likely than Schizophrenia Spectrum Disorder. The chronicity and nature of ST’s symptoms, along with his psychiatric history predating recent substance use, suggest that his psychotic symptoms are not solely attributable to substance use. However, substance use may be exacerbating his underlying psychotic Disorder.

Delusional Disorder (F22): Although ST displays paranoid thoughts, the presence of prominent hallucinations and the broader range of symptoms he experiences make Delusional Disorder a less fitting diagnosis. Delusional Disorder typically involves non-bizarre delusions without the significant functional impairment and hallucinations seen in ST’s case.

Critical Thinking Process

The primary diagnosis of Schizophrenia Spectrum Disorder is supported by the long-standing nature of ST’s symptoms, their impact on his functioning, and his history of psychiatric hospitalizations. The presence of both positive and negative symptoms, along with disorganized thinking, aligns closely with the DSM-5-TR criteria for schizophrenia. While substance use is a complicating factor, the onset and persistence of symptoms beyond periods of intoxication or withdrawal suggest an underlying psychotic disorder rather than a purely substance-induced condition.

Pertinent positives include auditory and visual hallucinations, paranoid thoughts, social withdrawal, and a history of multiple psychiatric hospitalizations. Pertinent negatives include the absence of manic episodes, which helps rule out bipolar Disorder with psychotic features, and the presence of hallucinations, which is less common in Delusional Disorder.

Plan

The comprehensive treatment plan for ST encompasses pharmacotherapy, psychotherapy, substance use treatment, psychoeducation, family involvement, social support, health monitoring, safety planning, and regular follow-ups. The pharmacological approach involves restarting antipsychotic medication, specifically Risperidone, starting at 2 mg orally at bedtime and titrating up to 4 mg daily as tolerated. This choice is based on the efficacy of second-generation antipsychotics in treating both positive and negative symptoms of schizophrenia, with a relatively favorable side effect profile (Huhn et al., 2019). Concurrently, ST’s diabetes management will continue with Metformin, with the dosage to be confirmed with his primary care provider.

Psychotherapy, particularly Cognitive Behavioral Therapy for psychosis (CBTp), will be initiated with weekly sessions for 16 weeks. This approach can help ST manage his symptoms, challenge distorted thoughts, and develop coping strategies. Medication adherence and substance use will be addressed using motivational interviewing. ST’s concurrent substance use disorder requires a referral to a dual-diagnosis treatment facility that may use Motivational Enhancement Therapy (MET) to treat cocaine and alcohol.

Psychoeducation regarding schizophrenia, its symptoms, and treatment alternatives will be crucial to ST therapy. This instruction will stress medication adherence and substance use dangers. Antipsychotic side effects and management will be discussed, considering their metabolic and cardiovascular concerns (Correll et al., 2017; Stroup & Gray, 2018).

With ST’s approval, family engagement in treatment planning and family psychoeducation will be encouraged, especially his sister. Support and treatment outcomes can improve with this strategy. Social support and rehabilitation will include referrals to local schizophrenia support groups and vocational rehabilitation to address ST’s inadequate schooling and improve functional outcomes.

ST’s care plan must promote and monitor health. This includes setting baseline metabolic parameters, monitoring antipsychotic medication metabolic side effects, encouraging smoking cessation, and working with ST’s primary care provider to provide comprehensive diabetes and other physical health care. Given the higher mortality risk of psychiatric diseases like schizophrenia, this integrated strategy is crucial (Nemani et al., 2021).

With ST, a safety plan will include emergency contact numbers and symptom exacerbation management. Self-harm and other harm risk assessments will be done regularly. A first evaluation in 2 weeks will measure drug response and side effects, followed by monthly consultations for the first 3 months and further changes based on symptom stability. FOCUSED SOAP NOTE FOR SCHIZOPHRENIA SPECTRUM, OTHER PSYCHOTIC, AND MEDICATION-INDUCED MOVEMENT DISORDERS

Reflection

This case example raises many challenges and lessons. Knowing his paranoia and pharmaceutical suspicions, rapport/trust would be managed more strongly if we had to encounter again. Inherent in a strong therapeutic alliance is the key to improvement in effect of treatment. I still would investigate ST’s drug use, especially when he switched from marijuana to cocaine after his mother’s death. Knowing how his feelings of sadness and loss affect his substance use and symptom exacerbation might help tailor treatment. ST’s case raises some of the most critical legal and ethical issues engaged in autonomy vs. beneficence. On the one hand, he can refuse medication, but on the other hand, the pathophysiology of his disease impairs his judgment. Respect for his autonomy and duty to provide adequate care require careful consideration and continuous monitoring. Capacity for informed care decisions will have to be treated cautiously and monitored over time. Health promotion and disease prevention will have to take into consideration ST’s physical health. This patient has an increased risk for developing cardiovascular disease and metabolic syndrome because of schizophrenia, hence his treatment plan should include lifestyle interventions and regular monitoring of the status of physical health. Low education and social isolation of ST will mandate specific interventions in health literacy and access to resources. Psycho-educational interventions attuned to his level of knowledge, with a rated community support services will aid in the effectiveness of treatment and enhance quality of life.

Again, holistic, person-centered care is driven home in this case. ST will not improve or recover long term until his social determinants of health are addressed, such as stability at home, social relationships, and meaningful daily activities, not just his psychotic symptoms. ST’s story underscores the mental illness problem entwined with substance use and psychosocial problems. It puts into light the complex multidisciplinary care involving psychiatric symptoms and problems in life. The case is a classic scenario where, as a professional, continuous learning, sensitivity, and adaptability are called for in mental healthcare.

References

Correll, C. U., Solmi, M., Veronese, N., Bortolato, B., Rosson, S., Santonastaso, P., Thapa‐Chhetri, N., Fornaro, M., Gallicchio, D., Collantoni, E., Pigato, G., Favaro, A., Monaco, F., Kohler, C., Vancampfort, D., Ward, P. B., Gaughran, F., Carvalho, A. F., & Stubbs, B. (2017). Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large‐scale meta‐analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry, 16(2), 163-180.
https://doi.org/10.1002/wps.20420

Huhn, M., Nikolakopoulou, A., Schneider-Thoma, J., Krause, M., Samara, M., Peter, N., Arndt, T., Bäckers, L., Rothe, P., Cipriani, A., Davis, J., Salanti, G., & Leucht, S. (2019). Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. The Lancet, 394(10202), 939-951.
https://doi.org/10.1016/s0140-6736(19)31135-3

Nemani, K., Li, C., Olfson, M., Blessing, E. M., Razavian, N., Chen, J., Petkova, E., & Goff, D. C. (2021). Association of psychiatric disorders with mortality among patients with COVID-19. JAMA Psychiatry, 78(4), 380-386.
https://doi.org/10.1001/jamapsychiatry.2020.4442

Psychiatry Simplified – Dr Sanil Rege. (2017, April 24). Movement Disorders with Antipsychotic Medication – Conversations with Dr Stephen Stahl [Video]. YouTube.

Scissus Animus. (2020, March 19). Realistic schizophrenia simulation [Video]. YouTube.

Stroup, T. S., & Gray, N. (2018). Management of common adverse effects of antipsychotic medications. World Psychiatry, 17(3), 341–356.
https://doi.org/10.1002/wps.20567
 FOCUSED SOAP NOTE FOR SCHIZOPHRENIA SPECTRUM, OTHER PSYCHOTIC, AND MEDICATION-INDUCED MOVEMENT DISORDERS

NRNP 6645 final exam questions 2025

Question 1                     1 pts

The therapist working with a patient diagnosed with borderline personality disorder is aware that which of the following attachment styles has been highly correlated with this disorder?

Group of answer choices

 

Secure attachment style

 

Unresolved attachment style

 

Preoccupied attachment style

 

Disorganized attachment style

 

Question 2                1 pts

Which of the following are psychotherapeutic techniques used in person centered psychotherapy?

Group of answer choices

 

A highly structured approach is used.

 

Process interventions are widely used.

 

Directive, interpretive techniques are used.

 

A nondirective-facilitative counseling approach is used.

 

Question 3                        1 pts

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a relationship-based treatment approach implemented with the parents and child.  The therapist is guided in this treatment technique with the following acronym associated with TF-CBT for the treatment of trauma in children:

Group of answer choices

 

PACE

 

PERFORM

 

PREVENT

 

PRACTICE

 

Question 4                          1 pts

Which of the following is true about dreamwork from a Gestalt perspective?

Group of answer choices

 

The individual tells the dream in past tense

 

Elements of the dream are viewed using standardized dream symbol meaning.

 

A dream diary is required to capture all elements of the team.

 

The characters and objects in the dream are projections of the individual whose dream it is.

 

Question 51 pts

Neuroscientists argue self-regulation development begins in childhood and involves developing inhibitory control with the integration of emotion with memory.  What areas of the brain do they claim are involved with this process?

Group of answer choices

 

Broca’s Area

 

Basal Ganglia

 

Wernicke’s Area

 

Frontal lobe in coordination with limbic structures

BUY EXAM HERE

Question 6                    1 pts

Which of the following therapeutic approaches would be a better choice for an older adult who presents with chronic depression, mild cognitive impairment expressing concerns about a negative life event and perceives himself as helpless?

Group of answer choices

 

Interpersonal Psychotherapy (IPT)

 

Cognitive Behavioral Therapy (CBT)

 

Cognitive Behavioral Therapy for Mild Dementia (CBT-MD)

 

Reminiscence Therapy (RT)

 

Question 71 pts

All of the following are guiding principles for 12-step Peer Support Groups for patients diagnosed with substance use disorders EXCEPT:

Group of answer choices

 

Examining past errors with the help of a sponsor

 

Recognizing a higher power that can give strength

 

Forgetting past errors and move forward without further thought

 

Admitting that one cannot control one’s addiction or compulsion

 

Question 9                    1 pts

An important element of child psychotherapy is goal setting. Which of the following demonstrates the best way to build therapeutic relationship in goal setting for family therapy:

Group of answer choices

 

Allowing only the child to participate in goal setting.

 

Allowing only the parent/guardian to participate in goal setting.

 

Allowing both the parent/guardian and child to participate in goal setting.

 

Allowing neither parent or child to participate in goal setting.. After careful assessment the therapist determines they should set the therapy goals.

 

Question 10               1 pts

When evaluating the concept of resiliency building in children through psychotherapy, the best outcome is defined as:

Group of answer choices

 

curing with psychotropic medication

 

healing so children can regulate their emotions/behaviors to be positively connected in their social environments

 

ensuring they child does not have disciplinary actions while in school

 

ensuring children do not have arguments with their siblings

 

NRNP 6645 final exam questions 2025  Question 11                                      1 pts

Research suggests that psychodynamic therapeutic approaches are effective for some children, particularly those with which of the following disorders?

Group of answer choices

 

Conduct Disorders

 

Anxiety and Depression

 

Depression and Psychosis

 

Attention Deficit-Hyperactivity Disorders

 

Question 12                                 1 pts

Which best describes gerotranscendence?

Group of answer choices

 

Erik Erikson’s ninth stage of development

 

Emphasizes ongoing growth over decrements

 

Focuses on the transition to old-old (80 years and older).

 

Focuses on letting go and coming to terms with end of one’s life

 

Question 13                                       1 pts

Advanced Practice Registered Nurses use medical evaluation and management (E/M) codes for billing treatment services.   The specific five-digit E/M code is chosen based on patient type, service location, and service level.  What do the third and fourth digits of an E/M code identify?

Group of answer choices

 

type of patient

 

location of service

 

both A and B are true

 

None of these

 

Question 14                                        1 pts

Gestalt therapists are aware patients have boundary disturbances in awareness and contact and bring awareness to these interruptions through ways to reduce them and restore self-regulation.  What is the interruption concept known to therapists to mean patients allow a blurring between themselves and their environment, they “try to blend in and get along with everyone”?

Group of answer choices

 

Introjection

 

Projection

 

Deflection

 

Confluence

 

Question 15                                     1 pts

The “here and now” approach in Humanistic-Existential Therapy is often a misunderstood concept where people believe talking about the “here and now” means the current present only when it truly means talking about the past, present, and future as if experienced in the present.

Group of answer choices

 

True

 

False

 

Question 161 pts

The primary source for constructive change in a humanistic-existential approach is which of the follow:

Group of answer choices

 

The patient’s motivation

 

The therapist’s structure

 

The therapist-patient relationship

 

The patient-family relationship

 

Question 171 pts

A specific type of CBT therapies aimed to reduce distress as a person experiences sensation  with danger is known as which of the following?

Group of answer choices

 

Exposure Therapy

 

Cognitive Rehearsal

 

Guided relaxation and meditation

 

Shame-Attacking

 

Question 181 pts

Which of the following is true about communication with children and adolescents?

Group of answer choices

 

Communication is developmentally based.

 

Offices should be free of toys or distractions.

 

Speak to children in adult manner as it lets them know you take them seriously.

 

Communicate at level lower than the child or adolescent to improve their self-esteem.

 

Question 191 pts

The following are specific strategies for working with adolescents versus adults in psychotherapy EXCEPT which of the following?

Group of answer choices

 

Therapist assumes a more active role

 

Stage of brain development is more of a consideration for therapy techniques implemented

 

It is especially helpful to leave extremely long silence episodes between interactions

 

Monitor nonverbal body language for worsening anxiety, gently move to another line of conversation, then circle back around to uncomfortable topic as build therapeutic relationship allows

 

Question 201 pts

Functional status refers to

Group of answer choices

 

A person’s capacity to manage activities of daily living independently

 

A person’s positive perspective on their own capabilities

 

A person’s expected increase in dependency as one ages

 

A person’s expected decrease in independence as one ages

 

Question 211 pts

According to Wheeler et al. (2020) which of the following is NOT supported by current evidence about Mental Health in older adults?

NRNP 6645 final exam questions 2025  Group of answer choices

 

At least 20% of older adults have one or more mental health or substance use conditions.

 

Mental illness is a normal part of aging.

 

There is an increasing need for behavioral health and substance abuse specialty services in primary care.

 

Mental health policy and treatment of older adults have lagged resulting in this population being underserved.

 

Question 221 pts

One key diagnostic feature for changing a diagnosis of Acute Stress Disorder to Posttraumatic Stress Disorder is the following:

Group of answer choices

 

symptoms develop after a trauma event and persist after 4 weeks

 

symptoms develop after a trauma event and persist for 2 weeks only

 

6 out of 14 diagnostic symptoms from the DSM-5 are noted after 3 days

 

there is no reported “sense of numbing”

 

Question 231 pts

Evidence supports which of the following statements about women and addictions treatment?

Group of answer choices

 

Women seeking treatment for substance use disorder are more likely than men to have experienced traumatic events.

 

Women are more apt to drop out of treatment than men.

 

Women are less likely than men to seek mental health services.

 

Women are less likely than men to participate in group therapy.

 

Question 241 pts

Which of the following Dialectical Behavioral Therapy (DBT) strategies are implemented by therapists based upon the knowledge that many patients in need of this psychotherapy treatment modality experience poor boundary maintenance as a way of attempting to influence others?

Group of answer choices

 

expression of a desire to have mutual respect and reassurance of desire for helping the patient

 

reassurance confidentiality within the limits of the law and ethical practice will be maintained which includes a duty to report clear risks of harm to self and/or others

 

maintaining clear boundaries of the therapeutic relationship including ethical conduct and separation of personal and professional roles

 

All of the above are important strategies for DBT

 

Question 251 pts

Which theorist is known as the founder of phenomenology and focused on a “person’s lived experience as the source of knowledge and truth”?

Group of answer choices

 

Freud

 

Jung

 

Husserl

 

Henderson

 

Question 261 pts

The primary goal for the stabilization stage of trauma treatment when considering patient safety before moving from the safety stage to the processing stage is for the patient to demonstrate:

Group of answer choices

 

self-regulation of internal states of arousal

 

disregarding trust and therapeutic relationships

 

work toward preventing traumatic countertransference

 

learn to deny the trauma

 

Question 271 pts

The loss of control over the intense urge to take a drug even at the expense of adverse consequences is known as which of the following?

Group of answer choices

 

Tolerance

 

Withdrawal

 

Addiction

 

A craving

 

Question 281 pts

Which of the following statements is consistent with a humanistic-existential approach when the patient starts talking about past event?

Group of answer choices

 

Tell me about your childhood.

 

Let’s just focus on the here and now.

 

Tell me the story as if it were happening now.

 

Tell me what happened last week.

 

Question 291 pts

McGovern et al (2014) have found which of the following therapeutic approaches helpful In working with post-stroke patients experiencing depression?

Group of answer choices

 

Interpersonal Therapy for Mild Cognitive Impairment (IPT-CT)

 

Problem-Solving Therapy for Executive Dysfunction (PST-ED)

 

Cognitive Behavioral Therapy for Mild Dementia (CBT-MD)

 

Ecosystem-Focused therapy (EFT)

 

Question 301 pts

The mother of a 6-year-old is concerned that the child seems to always want to pretend when playing. Which would be an appropriate response to the mother?

Group of answer choices

 

This shows some regression as most children of this age are in the concrete operational stage and play should be more realistic.

 

This is an appropriate activity for a child of this age consistent with Piaget’s sensorimotor stage.

 

Pretend play is an appropriate activity for a child in the Preoperational stage of cognitive development.

 

Pretend play shows the ability to think abstractly which indicates cognitive ability consistent with the formal operational stage of cognitive development.

 

Question 311 pts

Which of the following is true about the use of medications and/or psychotherapy in the treatment of patients diagnosed with Posttraumatic Stress Disorder (PTSD)?

Group of answer choices

 

Medication may be a helpful as an adjunctive treatment but is not a first-line treatment

 

Medication directly promotes new learning and processing.

 

Medications assuage the guilt, grief and interpersonal difficulties specifically in patients with PTSD.

 

Medications alone can cure PTSD

 

Question 321 pts

Dialectical Behavior Therapists realize which of the following:

Group of answer choices

 

Everyone with borderline personality has comorbid posttraumatic stress disorder (PTSD

 

Everyone diagnosed with PTSD can be diagnosed with comorbid borderline personality disorder.

 

There are important overlapping symptoms and neuropsychological correlates that PTSD and borderline personality disorder have in common.

 

DBT should only be used with individuals diagnosed with personality disorder or those with chronic suicidal thoughts.

 

Question 331 pts

In working with an older adult patient in the termination phase the therapist suggests it may be helpful to teach family members ways to support the patient and prevent relapse. This suggestion demonstrates which of the following?

Group of answer choices

 

A major HIPPA violation

 

Lack of confidence in the patient and the therapeutic process of CBT

 

An appropriate strategy to solidify a supportive network for the patient.

 

Resistance to terminating the therapeutic relationship.

 

Question 341 pts

The therapist using Dialectical Behavior Therapy with a patient with borderline personality disorder uses persuasive dialogue to do which of the following?

Group of answer choices

 

Invite the patient to new ways of viewing a situation

 

Guiding patient to develop more skills to achieve a greater quality of life.

 

Engage the patient in change talk

 

A and B

 

Question 361 pts

When referring a patient to a 12-step group the therapist realizes which of the following supports successful patient engagement in 12-step group participation?

Group of answer choices

 

Provide an overview of the 12-step approach, explain the concept of powerlessness and spirituality within the 12-step tradition.

 

Use Motivational Interviewing contracts for attendance at several different groups to find the right “fit” and encourage attendance.

 

Encourage patient to not worry about going to the groups because due to high attrition rates, most groups have many new patients at each session.

 

A and B only

 

Question 371 pts

Which of the following would NOT be a first-line intervention for an individual with Posttraumatic Stress Disorder?

Group of answer choices

 

CPT

 

CPT-PE

 

EMDR therapy

 

Pharmacological interventions.

 

Question 381 pts

The Gestalt therapist notices the patient is fidgeting with fingers, legs are shaking and asks the  patient “What are you experiencing right now in your body?” This is a type of creative experimentation known as which of the following?

Group of answer choices

 

Focusing

 

Body awareness

 

Language of responsibility

 

Empty-chair dialogue

Question 571 pts

The patient in Dialectical Behavior Therapy (DBT) is focusing on self-efficacy, interdependence, and self-dependence.  At times, the patient seems bored with therapy and informs the therapist of re-emerging thoughts of self-harming but does not want to act on these thoughts. The therapist using the DBT model of therapy would do which of the following?

Group of answer choices

 

Do nothing different.

 

Increase the frequency and intensity of processing the trauma

 

Decrease the frequency and intensity of processing the trauma

 

Immediately hospitalized the patient without further assessment

 

Question 581 pts

Which of the following is true about Complementary and Alternative Medicine (CAM) Therapies and Older Adults?

Group of answer choices

 

CAM therapies are a good alternative to conventional medicine

 

CAM therapies can be used in conjunction with psychotherapy to provide effective, evidence-based treatments to older adults with psychiatric disorder.

 

Evidence is unclear whether CAM therapies improve quality of life or wellness in older adults.

 

Most middle age and older adults are reluctant to use CAM therapies for management of mental health concerns.

 

Question 591 pts

The most effective treatment for SUD with or without co-morbid psychiatric disorders is:

Group of answer choices

 

Multidimensional addressing medical, psychosocial and mental health issues

 

Trauma-informed care.

 

12-Step Peer Support Groups

 

Cognitive Behavioral Therapy

 

Question 601 pts

The following is considered the first-line treatment recommendation for Postraumatic Stress Disorders:

Group of answer choices

 

Electroconvulsive Therapy

 

Psychotropic Medications

 

Psychotherapy

 

None of these

 

Question 611 pts

Which of the following is not consistent with the Dialectical Behavior Therapy approach to boundary maintenance?

Group of answer choices

 

Clarify explicitly the boundaries of the therapeutic relationship.

 

The therapist will maintain confidentiality within the limits of the law and ethical practice.

 

Explain a professional relationship is based on mutual respect and the desire to help the patient.

 

Maintain a rigid distant relationship with the patient to avoid any mixed messages to the patient.

 

Question 621 pts

Which of the following screening tools for alcohol and drug use is recommended specifically for the target population of pregnant women:

Group of answer choices

 

AUDIT-C

 

CRAFFT

 

CAGE

 

UNCOPE

 

Question 641 pts

A Trauma Resiliency Model therapist encourages the patient to describe the “felt sense” of internal or external body sensations associated with resilience, stress, and release. This is known as which of the following Trauma Resiliency Model skills?

Group of answer choices

 

Tracking

 

Resourcing and resource intensification

 

Grounding

 

Gesturing

 

Question 651 pts

The concept of resiliency in child therapies is in direct contrast to which traditional approach for treating children?

Group of answer choices

 

Family inclusion

 

The concept of recovery

 

Problem-based therapy

 

Interacting systems consideration

 

NRNP 6645 final exam questions 2025  Question 661 pts

An organized, consistent set of perceptions about the self, continually influenced by experience and its interpretation which includes self-worth, self-image and ideal self, is which key concept of person-centered therapy?

Group of answer choices

 

Belief of human nature

 

Self-concept

 

Actualizing tendency

 

Fully functioning person

 

Question 671 pts

Clinical practice guidelines recommend the use of psychotropic medications in combination with psychotherapy for which of the following child and adolescent severe emotional disorder:

Group of answer choices

 

Pediatric bipolar disorder

 

Insomnia

 

Attachment Disorder

 

Oppositional Defiant Disorder

 

Question 681 pts

In working with an older adult female patient, the therapist notices that the patient starts bringing her baked goods.  Once the patient stated, “You remind me so much of my daughter, you are so easy to talk to.” The therapist recognizes this interaction is related to the following concept:

Group of answer choices

 

Gerotranscendence

 

Transference

 

Countertransference

 

Time for termination

 

Question 691 pts

Patient-reported signs of dissociation may include all the following EXCEPT:

Group of answer choices

 

Feeling out of touch with surroundings

 

Feeling like they are on autopilot

 

Things sound different, muffled or too loud, tiny, or echoing

 

Body becomes still or stiff

 

Question 701 pts

Which of the following capture techniques of interviewing communication skills with the acronym OARS (open questions, affirming, reflecting, summarizing)?

Group of answer choices

 

Couples Interviewing Skills

 

Family Interviewing Skills

 

Interpersonal Interviewing Skills

 

Motivational Interviewing Skills

 

Question 711 pts

Medication management sessions, psychotherapy sessions, and combination medication management with add-on psychotherapy sessions will all have different billing codes and reimbursement rates; therefore, advanced practice nurses who conduct psychotherapy as well as prescribe psychotropic medications must have a good understanding of the differences as well as the documentation requirements for each type of session.

Group of answer choices

 

True

 

False

 

Question 721 pts

A patient whose husband had recently died suddenly expresses remorse regarding an argument they  had shortly before his death. The Gestalt Therapist would likely use which of the following techniques to complete unfinished business?

Group of answer choices

 

Empty-chair dialogue

 

Dreamwork

 

Language of responsibility

 

Focusing

Question 731 pts

All of the following support emotional stability and well-being in older adults EXCEPT:

Group of answer choices

 

Diminished functional status

 

sense of personal control and empowerment

 

decisional control

 

resilience in recovery

 

Question 741 pts

An older adult female talks frequently about her love of gardening as a way of coping.  The therapist begins to realize after self-reflection that she allows the therapy session to move more toward a discussion of the love for flowers instead of focusing on the patient’s concerns because the therapist’s deceased mother also had a love of gardening.  This phenomenon is best known as:

Group of answer choices

 

Gerotransference

 

Transcendence

 

Countertransference

 

A sign of a close therapeutic relationship

Question 751 pts

Which of the following is a biologically based psychotherapy model best known to be used to treat patients who have experienced trauma?

Group of answer choices

 

Trauma Resiliency Model

 

Cognitive Behavioral Therapy

 

Existential Psychotherapy

 

Psychodynamic Psychotherapy

 

Question 761 pts

Which therapy approach has been shown to be effective in reducing depressive symptoms and suicidality in older adult with co-existing personality disorders?

Group of answer choices

 

Dialectical Behavior Therapy (DBT)

 

Ecosystem-Focused Therapy (EFT)

 

Cognitive Behavioral Therapy for Executive Dysfunction (CBT-MD)

 

Problem Adaptation Therapy (PATH)

 

Question 781 pts

The patient participating in Dialectical Behavior Therapy with a history of self-harming through cutting, the patient has been focusing on non-traumatizing emotional experiences and has shown progress in behavior control and management of emotions.   The therapist recognizes the patient is ready for which of the following:

Group of answer choices

 

The patient is ready to focus on building a therapeutic relationship

 

The patient is ready to focus on how to cope with scars

 

The patient is ready to focus on past trauma events

 

The patient is ready to focus on termination from therapy.

 

Question 791 pts

Which of the following is NOT consistent with a family-centered approach in child therapy?

Group of answer choices

 

In family-centered treatment, the family is the focus of treatment.

 

Family- centered treatment is appropriate to improve family interactions.

 

Family-centered treatment is appropriate to keep families engaged in services

 

Family-centered treatment is appropriate to increase family knowledge about mental health.

 

Question 801 pts

The therapist notices in working with a patient with a dissociative disorder that the person appears to be doing worse after significant gains are made. The therapist understands the reason for this phenomenon is likely which of the following:

Group of answer choices

 

This indicates the change(s) really did not take

 

The patient is consciously sabotaging the therapy.

 

This indicates process is trying to force a change too fast.

 

As positive changes occur they may be followed by a temporary increase in sadness, anger, or anxiety because even positive change may be experienced as a loss.

 

Question 811 pts

The MOST fundamental art aspect for a therapist in the science practice of Dialectical Behavioral Therapy treatment is assisting the patient with:

Group of answer choices

 

accepting and changing behaviors, to step out of comfort zone, synthesize fear and pain, and develop new skills/characteristics for greater quality of life

 

drawing genograms

 

uncovering lies the patient has told

 

pointing out the damage created by patient behaviors

Question 821 pts

The therapist working with the older adult cohort recognizes:

Group of answer choices

 

As a group, the elderly, regardless of specific age, race or experiences have similar issues.

 

This is basically the baby boomer generation, with great empowerment and entitlement

 

This enlightened cohort sees no stigma with mental health diagnosis or treatment.

 

There is great diversity with individual variation and cohort effects

 

Question 831 pts

The advanced practice registered nurse can add time reviewing charts, reviewing results of tests, ordering medications, collaborating with other professionals, insurance pre-authorizations, and interacting with the pharmacy to patient face-to-face billing times if these activities occur on the same day the patient is seen for the visit.

Group of answer choices

 

True

 

False

 

Question 841 pts

The person-centered therapist who is genuine and authentic during the therapy session is exhibiting       which psychological condition?

Group of answer choices

 

Congruence

 

Actualizing tendency

 

Belief of human nature

 

Accurate empathic understanding

 

NRNP 6645 final exam questions 2025  Question 85 1 pts

Challenges assessing psychiatric symptoms in older adults include which of the following EXCEPT:

Group of answer choices

 

Denial of symptoms

 

Age-related variations in symptom presentation

 

Masking of symptoms by comorbid disorders and medications

 

Ease in obtaining an accurate mental health history

 

Question 871 pts

Constructing from a biopsychosocial Four Perspectives framework, the therapist will use the following “four Ps” when formulating treatment goals for children:

Group of answer choices

 

predisposing, precipitating, perpetuating, and protective factors

 

predictive, promising, percolating, and protective factors

 

precipitating, purposeful, processing, and protective factors

 

prescribing, populating, performing, and protective factors

GET EXAM HELP HERE

Question 881 pts

The therapist proficient in Interpersonal Psychotherapy (IPT) is working with an older adult.  The patient does not recognized she has depression. Which of the following is true?

Group of answer choices

 

IPT is not an appropriate model for treating depression in older adults.

 

This is a common IPT issue with older adults during the initial sessions.

 

The therapist should consider using a standardized scale to quantify the depression and use this to educate the patient and the family.

 

B and C

 

Question 891 pts

Addiction is now recognized as:

Group of answer choices

 

A primary disease of the brain’s neurocircuitry

 

A volitional behavior that can be managed independently’

 

A family issue to be dealt with privately

 

A volitional behavior that will never be cured

 

Question 901 pts

Which of the following is NOT consistent with Eye Movement Desensitization and Reprocessing (EMDR)  in treating patients diagnosed with Posttraumatic Stress Disorders?

Group of answer choices

 

Treatment effects are witnessed in patients at rates of 77%-100% of with remission after 3-6 sessions

 

EMDR requires homework

 

EMDR treatment mechanism of action is unclear

 

EMDR was the first psychotherapy to demonstrate neurophysiological effects in response to treatment

 

Question 911 pts

In providing psychoeducation to a patient in recovery from substance use disorders, the therapist would NOT include which of the following?

Group of answer choices

 

Recovery is a lifelong process of change

 

A patient is considered recovered after 6 months free of substance use.

 

Recovery encompasses dimensions of health, home, purpose and community.

 

Recovery applies to recovery from mental disorder, substance use disorders and behavioral addictions.

 

Question 931 pts

In diagnosing children and adolescents with mental health disorders, the therapist must remember the following considerations to be true:

Group of answer choices

 

children’s psychiatric diagnoses are not static and can change over the years

 

taxonomies do not provide for a child or adolescent presentation that might be a blend of behaviors that do not fit one existing diagnostic criteria

 

Both A and B are true

 

None of these are true

 

Question 941 pts

A therapist specializing in the treatment of patients diagnosed with Posttraumatic Stress Disorders begins to experience disturbing dreams, anxiety, increased fatigue, and irritability. These symptoms are consistent with the phenomenon of:

Group of answer choices

 

Transference

 

Countertransference

 

Secondary trauma

 

Burnout

 

Question 951 pts

The therapist understands the following statements regarding traits identified for individuals diagnosed with personality disorders include all the following EXCEPT:

Group of answer choices

 

Often these individuals will see their problems as independent of their own behaviors.

 

These individuals will often describe themselves as a victim.

 

These individuals often present for treatment at the request of a significant other or other external pressure.

 

These individuals already have resiliency in coping.

 

Question 971 pts

Using a psychodynamic psychotherapy stage-oriented model for the treatment of trauma, the therapist would do which of the following in Stage 1?

Group of answer choices

 

Address safety issues

 

Process painful memories

 

Promote symptoms stabilization

 

A and B are true

 

Question 981 pts

What two therapeutic strategies assist with developing “dual awareness” for patients in the treatment of trauma?

Group of answer choices

 

Grounding and Managing Flashbacks

 

Mindfulness and Rating of Level of Disturbance

 

Sleep Hygiene and Administering Psychotropic Medication

 

None of these are true

 

Question 1001 pts

Dysregulation of this area of the brain is associated with memory problems and this person may be unable to integrate memories into the present and personal memory into identity, and thought to underlie symptoms of flashbacks, nightmares, avoidances and dissociation.

NRNP 6645 final exam questions 2025  Group of answer choices

Locus coeruleus

Cerebellum

Thalamus

Hypothalamus

Question 201 pts

Symptoms of Polycystic Ovary Syndrome (PCOS) include all of the following except:

Group of answer choices

 

Acne

 

Menstrual irregularity

BUY EXAM HERE

Hirsutism

 

Hypopigmentation of the extremities

 

NRNP 6552 Midterm Exam
Walden University

NRNP 6675 Final Exam Questions and Answers 2025

Question 1           1 pts

A form of child abuse in which a parent or caretaker repeatedly fabricates or actually inflicts injury or illness in a child for whom medical intervention is then sought, often in an emergency setting, is known as which of the following?

Group of answer choices

 

Korsakoff’s syndrome

 

Snyder’s syndrome

 

Munchausen syndrome

 

Munchausen syndrome by proxy

 

Question 2                 1 pts

The only approved therapy in the United States for moderate to severe Alzheimer’s disease is which of the following?

Group of answer choices

 

Donepezil

 

Memantine

 

Rivastigmine

 

Galantamine

 

Question 3           1 pts

An ARNP takes a position agreeing to be paid the amount the NP bills minus accounts receivable and minus the NPs portion of practice expenses (which includes the expense of physician consultation). This type of pay structure is known as which of the following?

Group of answer choices

 

Straight salary

 

Average percentage of net receipts

 

Base salary plus percentage

 

Hourly rate

 

Question 4                    1 pts

At a minimum, a psychiatric evaluation in an emergency should include which of the following? Select all that apply.

Group of answer choices

 

Is the patient psychotic?

 

Is the patient suicidal or homicidal?

 

Is the problem organic, functional, or a combination?

 

Is it safe for the patient to be in the emergency room?

 

Question 5             1 pts

In order to qualify for ANCC board certification testing you must have a minimum of how many supervised clinical hours in the respective specialty for which you are seeking certification?

Group of answer choices

 

300 supervised clinical hours

 

500 supervised clinical hours

 

600 supervised clinical hours

 

800 supervised clinical hours

 

Question 6           1 pts

The conditions in which people are born, grow, work, live, and age are known as which of the following?

Group of answer choices

 

Health literacy

 

Health disparities

 

Health vulnerabilities

 

Social determinants of health

 

Question 7            1 pts

Which of the following is consistent with current literature regarding the epidemiology of dependent personality disorder?

Group of answer choices

 

Dependent personality is more common in men than in women.

 

Dependent personality disorder is more common in young children than in older ones.

 

Persons with chronic physical illness in childhood may be most susceptible to this disorder.

 

B and C only

GET EXAM HELP HERE

 

Question 8                1 pts

Which of the following symptoms of borderline personality disorder assist in differentiating borderline personality disorder from schizophrenia?

Group of answer choices

 

Chronic feelings of emptiness

 

Prolonged psychotic episodes

 

Demand extraordinary relationships

 

A and C only

 

Question 9            1 pts

The ARNP is working with a patient who has a heightened sense of self-importance and grandiose feelings of uniqueness. The patient also lacks empathy for others, although is very sensitive to minor criticism. The ARNP recognizes these symptoms as consistent with which of the following personality disorders?

Group of answer choices

 

Schizotypal personality disorder

 

Borderline personality disorder

 

Narcissistic personality disorder

 

Histrionic personality disorder

 

Question 10              1 pts

A patient prescribed clozapine presents to the ED with high fever, pharyngitis, and perianal ulceration. You suspect which of the following?

Group of answer choices

 

Influenza

 

Agranulocytosis

 

Neuroleptic malignant syndrome

 

Acquired immune deficiency syndrome

 

Question 11          1 pts

According to Sullivan, which of the following are consistent with a mentor/mentee relationship?

Group of answer choices

 

Mentors are assigned

 

Mentor relationships are shorter term

 

Goals for the mentoring relationship are set mutually.

 

A and B only

 

Question 12         1 pts

Which of the following professionals would be able to precept a nurse practitioner student?

Group of answer choices

 

An advanced registered nurse practitioner

 

A physician

 

A unlicensed social worker

 

A and B

 

Question 13         1 pts

As a PMHNP, one of the most common areas you will counsel your patients about is the importance of sleep hygiene. Which of the following is NOT consistent with common recommendations for good sleep hygiene?

Group of answer choices

 

Avoid alcohol and caffeine.

 

Set a cool room temperature.

 

Set TV to turn off within 1 hour of falling asleep.

 

Go to bed at the same time each night.

 

Question 14                 1 pts

Patients who injure themselves by self-mutilation (i.e., cutting their skin) but who usually do not wish to die are said to have which of the following?

Group of answer choices

 

Suicide intent

 

Suicidal ideations

 

Parasuicidal behavior

 

Aborted suicide attempt

 

Question 15             1 pts

A late-appearing adverse effect of neuroleptic drugs is known as which of the following?

Group of answer choices

 

Akathisia

 

Parkinsonism

 

Neuroleptic malignant syndrome

 

Neuroleptic-induced tardive dyskinesia

 

Question 17       1 pts

A somatopsychic illness triggered by changing levels of sex steroids that accompany an ovulatory menstrual cycle about one week before the onset of menses characterized by irritability, emotional lability, HA, anxiety, and depression is known as which of the following?

Group of answer choices

 

Premenstrual syndrome

 

Premenstrual depression

 

Premenstrual dysphoric disorder

 

Premenstrual psychosomatic disorder

 

Question 18      1 pts

The term “suicide survivor” refers to which of the following?

Group of answer choices

 

Those who have lost a loved one to suicide.

 

Someone who has attempted suicide but failed.

 

Only those who have had a serious suicide attempt with a near death experience.

 

This is an ambiguous term that should not be used.

 

Question 19           1 pts

Standard of care addresses which of the following questions?

Group of answer choices

 

Did the clinician do the right thing at the right time?

 

Was effective care provided to the patient?

 

Was care provided safely regardless of time frame?

 

A and B only

 

Question 20         1 pts

Loyalty, fairness, truthfulness, advocacy, and dedication in professional relationships is known as which of the following?

Group of answer choices

 

Justice

 

Fidelity

 

Non-maleficence

 

Respect for autonomy

 

Question 21               1 pts

Which of the following is not consistent with Leininger’s theory on diversity and universality?

Group of answer choices

 

For a caregiver’s work to be meaningful and relevant, transcultural knowledge and competence is imperative to guiding decisions and actions for successive outcomes.

 

Is suitable for application to the care of diverse populations

 

States that provision of care needs to be harmonious with an individual’s or group’s cultural beliefs, practices, and ideals.

 

States that provision of care needs to be harmonious with the provider’s cultural beliefs, practices, and ideals.

 

Question 221 pts

The ARNP recognizes which of the following as long-term effects of sex trafficking on victims?

Group of answer choices

 

Severe depression

 

Spiritual questions

 

Trauma bonding

 

All of the above

 

Question 23               1 pts

Which of the following medications is associated with Ebstein’s anomaly when given during pregnancy?

nrnp 6675 final exam questions and answers Group of answer choices

 

Haldol

 

Lithium

 

Valproic acid

 

Chlorpromazine

 

Question 241 pts

Self-care strategies for the ARNP in preparing for the certification exam include all of the following EXCEPT:

Group of answer choices

 

Study in a distraction free environment.

 

Six to eight hours of sleep is recommended.

 

Drink lot of caffeine and eat high-concentrated sugars.

 

Plan to study for short periods of time over a longer time period.

 

Question 25             1 pts

Which of the following is not advised to prevent a lawsuit?

Group of answer choices

 

Follow-up

 

When in doubt, do nothing

 

Know the standard of care and practice within it.

 

When in doubt, take a conservative approach.

 

Question 261 pts

Which of the following are important measures by which to evaluate a benefits package while negotiating employment benefits?

Group of answer choices

 

What benefits does the ARNP need?

 

What is reasonable?

 

What are other NPs getting?

 

All of the above

 

Question 271 pts

ARNPs caring for vulnerable populations are responsible for which of the following?

Group of answer choices

 

Providing a quick assessment

 

Providing housing

 

Recognizing and responding to the needs of the population in a time-sensitive manner

 

All of the above

 

Question 281 pts

Which of the following is consistent with recommendations regarding assessing for suicidal ideations?

Group of answer choices

 

The clinician should always ask about suicidal ideations as part of every mental status examination.

 

Assessing for suicidal ideations is only required if patient is depressed.

 

Asking a psychotic patient if they are having suicidal ideations is not advised as this could introduce the idea to the patient.

 

If a patient who has been threatening suicide becomes quiet and less agitated, it is safe to assume the suicidal ideations have subsided.

 

Question 291 pts

A clause in an employment agreement that restricts and employee from practicing within a set number of miles from an employer’s business for a set period of time after the employee leaves the employer’s business is known as which of the following?

Group of answer choices

 

Restrictive covenant

 

An employment clause

 

A termination clause

 

A termination covenant

 

Question 301 pts

Obsessive-compulsive, dependent, and avoidant personality traits are associated with which of the following personality clusters?

Group of answer choices

 

Cluster A

 

Cluster B

 

Cluster C

 

Cluster D

 

Question 311 pts

The NP can impact health policy and healthcare by doing which of the following?

Group of answer choices

 

Become an active member of local, state, and/or national NP organizations.

 

Become familiar with the resources available on NP organization websites.

 

Volunteer to serve on legislative committees within professional NP organizations.

 

All the above

 

Question 321 pts

A clause in an employment contract that specifies that an employer and employee may end the working agreement without cause within a specified number of days is known as which of the following?

Group of answer choices

 

a, A restrictive covenant

 

An employment clause

 

A termination clause

 

A and C

 

Question 341 pts

Cultural Dimensions Theory is a framework for cross-cultural communication that describes the effects of a society’s culture on the values of its members. It was developed by which of the following theorists?

Group of answer choices

 

Hofstede

 

Leininger

 

Purcell

 

Campinha-Bacote

 

Question 351 pts

Being knowledgeable about one’s own thoughts, feelings, and sensations as well as the ability to reflect on how these can affect one’s interactions with others is known as which of the following?

Group of answer choices

 

Cultural Awareness

 

Cultural Competence

 

Cultural Humility

 

Cultural Sensitivity

 

Question 361 pts

“Assumes complex and advanced leadership roles to initiate and guide change” is a NP core competency for which NP competency area?

Group of answer choices

 

Policy competencies

 

Quality competencies

 

Leadership competencies

 

Practice inquiry competencies

 

Question 371 pts

According to the AANP Process of Care Standards, performing or ordering preventative and diagnostic procedures based on the patient’s age and history is part of which of the following components?

Group of answer choices

 

Assessment of health status

 

Development of a treatment plan

 

Implementation of the treatment plan

 

Care priorities

 

Question 381 pts

Which of the following medications is associated with neural tube defects when given during pregnancy?

Group of answer choices

 

Iron

 

Haloperidol

 

Valproic acid

 

Chlorpromazine

 

Question 391 pts

The failure of a professional to exercise that degree of skill and learning commonly applied by the average prudent, reputable member of the profession is known as which of the following?

Group of answer choices

 

Negligence

 

Malpractice

 

Causation of injury

 

Duty liability

 

Question 401 pts

Persons who exhibit impulsive traits also show high levels of which of the following hormones? Select all that apply.

nrnp 6675 final exam questions and answers Group of answer choices

 

Testosterone

 

17-estradiol

 

Estrone

 

A and C only

 

Question 411 pts

Which of the following is the therapeutic blood level range for lithium?

Group of answer choices

 

0.2–1.0 mEq/L

 

0.3–0.8 mEq/L

 

0.3–1.2 mEq/L

 

0.5–1.5 mEq/L

 

Question 421 pts

Risk factors for school violence include which of the following? Select all that apply.

Group of answer choices

 

Bullying

 

Being bullied

 

Isolation

 

Involvement in school organizations

 

 

 

Question 571 pts

Acknowledging a person’s right to make choices, to hold views, and to take actions based on personal value is known as which of the following?

Group of answer choices

 

Justice

 

Fidelity

 

Beneficence

 

Respect for autonomy

 

Question 581 pts

Standards of care are now being set, modified, monitored, and publicized by certain self-appointed consumer-oriented agencies, as well as government agencies, including which of the following?

Group of answer choices

 

Medicare

 

The Joint Commission

 

The Agency for Healthcare Research and Quality

 

All of the above

 

Question 591 pts

A patient presents with a formal, tense manner. He reluctantly reports a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects the patient likely has which of the following personality disorders?

Group of answer choices

 

Schizoid personality disorder

 

Paranoid personality disorder

 

Borderline personality disorder

 

Antisocial personality disorder

Question 601 pts

Which of the following is not consistent with recommendations for psychiatric history taking and the mental status evaluation of older adults?

Group of answer choices

 

When a patient is cognitively impaired, an independent history should be obtained from a family member or caretaker.

 

The patient should still be seen alone even in cases of clear evidence of impairment to preserve the privacy of the doctor/patient relationship.

 

If the patient is cognitively impaired, the patient should never be seen alone.

 

Even in patients with cognitive impairment, it is important to elicit any suicidal thoughts or paranoid ideations privately.

 

Question 611 pts

A term that defines a person who has distress with clinical symptomatology because their gender identity is not consistent with gender assigned at birth is which of the following?

Group of answer choices

 

Cisgender

 

Gender fluid

 

Pangender

 

Gender dysphoria

 

Question 621 pts

The Adverse Childhood Experience Study (Felitti et al., 1998) found which of the following relationships between child traumatic events and high-risk behaviors exhibited by adults?

Group of answer choices

 

The study revealed a causal relationship between child traumatic events and high-risk adult behaviors.

 

The study revealed a causal relationship between child traumatic events and high-risk adult behaviors.

 

The study revealed no relationship between child traumatic events and high-risk adult behaviors.

 

The study revealed an indirect relationship between child traumatic events and high-risk adult behaviors.

 

Question 641 pts

Curriculum content that supports the NP scientific foundation competency area includes which of the following? Select all that apply.

Group of answer choices

 

Comparison of patient data sets with evidence-based standards to improve care

 

Science from other disciplines relevant to health care

 

High reliability organization principles.

 

Compliance issues related to patient privacy with use of technology.

 

Question 661 pts

A method of therapy used to treat individuals with substance abuse based on the fundamental principle of a psychology that reinforced behaviors are likely to be repeated is known as which of the following?

Group of answer choices

 

Exposure therapy

 

Contingency management

 

Motivational interviewing

 

Cognitive behavioral therapy

 

Question 671 pts

The obligation to not inflict harm or balancing unavoidable harm with benefits of good achieved is known as which of the following?

Group of answer choices

 

Fidelity

 

Beneficence

 

Non-maleficence

 

Respect for autonomy

 

Question 681 pts

All the following is consistent with ANCC rules regarding recertification EXCEPT:

nrnp 6675 final exam questions and answers Group of answer choices

 

You are required to have a maximum of 25 credit hours during each certification period.

 

You can start the recertification process 1 year before your expiration date, but no later than 3 months before.

 

You must have 1000 clinical practice hours in the clinical specialty within the preceding 5 years.

 

You must have at least 25 contact hours in pharmacotherapy.

 

Question 691 pts

Which of the following is consistent with what is known about terrorist-bomber suicides?

Group of answer choices

 

The goal is death or escape.

 

The motivation is vengeance and mass murder.

 

Psychological/psychiatric disorder is present in most cases.

 

A and B only

 

Question 701 pts

All of the following are risk factors for sexual assault EXCEPT

Group of answer choices

 

Religion

 

Serious mental illness

 

Substance use disorder

 

Family history of sexual abuse

 

Question 711 pts

In Canterbury v. Spence the U.S. Court of Appeals for the District of Columbia Circuit listed physician responsibilities for disclosure. Which of the following is not listed as a responsibility?

Group of answer choices

 

Adopt a standard of full disclosure with patients.

 

Alert the patient to symptoms of bodily abnormality.

 

Inform the patient when the ailment does not respond to the physician’s ministrations.

 

Inform the patient about precautionary therapy that he or she should seek in the future.

 

Question 731 pts

According to the AANP Process of Care Standards, determining the effectiveness of the treatment plan with documentation of patient care outcomes is part of which of the following components?

Group of answer choices

 

Care priorities

 

Development of a treatment plan

 

Implementation of the treatment plan

 

Follow-up and evaluation of the patient status

 

Question 751 pts

A claim of malpractice requires that a patient/plaintiff prove which of the following? Select all that apply.

Group of answer choices

 

The existence of a client-professional relationship – duty to care.

 

Behavior below the appropriate standard of care for professionals dealing in like circumstances.

 

A causal link between the practitioner’s failure to conform to treatment standards and harm to the patient.

 

Actual injury to the patient.

 

Question 761 pts

Cluster A personality traits consist of which of the following?

Group of answer choices

 

Schizotypal, schizoid, and paranoid subtypes

 

Narcissistic, borderline, antisocial, and histrionic subtypes

 

Obsessive-compulsive, dependent, and avoidant subtypes

 

Depressive, anxious, hypomanic subtypes

 

 

Question 841 pts

Low health literacy has been linked with which of the following?

Group of answer choices

 

Poor health outcomes

 

lower rates of hospitalization

 

Less frequent use of preventive services

 

All of the above

 

Question 851 pts

Which of the following is consistent with what is known about postpartum depression?

Group of answer choices

 

Feelings of guilt and inadequacy are often present and excessive.

 

Thoughts of harming the baby are often present.

 

Typical onset is within 3–6 months after delivery.

 

All of the above

Question 861 pts

An enduring pattern of behavior and inner experiences that deviates significantly from the individual’s cultural standards and produces functional impairment or subjective distress is consistent with which of the following?

Group of answer choices

 

Dysphoric disorder

 

General personality disorder

 

Dysfunctional personality traits

 

Developmental personality disorder

 

Question 871 pts

Which of the following demographic characteristics is consistent with high suicide risk?

Group of answer choices

 

Female

 

Married

 

Employed

 

Over 45 years of age

 

Question 881 pts

Patients with this personality disorder are described as excitable and emotional, and behave in a colorful, dramatic, extroverted, attention-seeking fashion, often with an inability to maintain deep long-lasting attachments.

Group of answer choices

 

Borderline personality disorder

 

Histrionic personality disorder

 

Schizotypal personality disorder

 

Narcissistic personality disorder

 

Question 891 pts

A patient with an inability to conform to the social norms that ordinarily govern many aspects of a person’s behavior is consistent with which of the following personality disorders?

Group of answer choices

 

Avoidant personality disorder

 

Antisocial personality disorder

 

Borderline personality disorder

 

Narcissistic personality disorder

 

Question 901 pts

Risk factors for physical abuse include all of the following EXCEPT:

Group of answer choices

 

Literacy

 

Pregnancy

 

Serious mental illness

 

History of victimization during developmental years.

 

Question 911 pts

The emotional burnout and lack of empathy towards clients that healthcare providers experience after treating victims of trauma is known as which of the following?

Group of answer choices

 

Compassion fatigue

 

Primary traumatization

 

Transference

 

Countertransference

 

Question 921 pts

Which of the following is consistent with what is known about personality disorders?

Group of answer choices

 

Typical onset in early childhood

 

Is stable over time

 

Involves impairment in at least one of four areas of cognition, affectivity, interpersonal function or impulse control

 

B and C only

 ORDER EXAM HELP NOW

Question 93                  1 pts

Non-pharmacological treatment for abuse includes all of the following EXCEPT:

Group of answer choices

 

Cognitive behavioral therapy

 

Build a community of support

 

Assist patient to devise safe escape plan

 

Involve the abuser in the treatment planning

 

Question 941 pts

Generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following lithium levels?

nrnp 6675 final exam questions and answers Group of answer choices

 

0.8–1.5 mEq/L

 

1.5–2.0 mEq/L

 

2.0–2.5 mEq/L

 

> 2.5 mEq/L

 

Question 95                   1 pts

The ARNP is treating a 27-year-old female with bipolar disorder who is obese and has renal dysfunction. Which of the following is true?

Group of answer choices

 

Lithium is the gold standard and should be used.

 

Lithium should be avoided in patients with renal disease.

 

An atypical antipsychotic such as olanzapine or risperidone should be used.

 

Depakote is the best option for this patient.

 

Question 96                       1 pts

Which of the following would constitute negligence? Select all that apply.

Group of answer choices

 

Failure to give necessary care.

 

Failure to refer when necessary.

 

Failure to follow-up with a patient.

 

Failure to disclose necessary information to a patient.

 

Question 97                  1 pts

According to Freud, passive and dependent personality traits are associated with which stage of development?

Group of answer choices

 

Oral stage

 

Anal stage

 

Phallic stage

 

Latency stage

 

Question 100             1 pts

According to the National Organization for Nurse Practitioner Faculties (NONPF), the policy competency area for the NP graduate includes all the following EXCEPT:

Group of answer choices

 

The NP graduate demonstrates an understanding of the interdependence of policy and practice.

 

The NP graduate advocates for ethical policies that promote access, equity, quality, and cost.

 

The NP graduate advocates for the nursing profession.

 

The NP graduate contributes to the development of health policy.

Question 19                                         1 pts

The average age for females to start having a menache is;

Group of answer choices

 

12 years of age

 

13 years of age

ORDER EXAM HELP HERE

15 years of age

 

16 years of age

 

NRNP 6552
Midterm Exam Walden University

The Five-Paragraph Essay Structure: How to Write a Five-Paragraph Essay

Writing a paragraph

This guide shows the three main parts of an essay and explains what should be contained within each paragraph. Paragraphs are the building blocks of any essay, we need to understand what a paragraph is and how it is structured to write a good essay. It contains the Topic sentence, the argument, evidence to it, a discussion and the concluding sentence.

What is a paragraph?

Within each paragraph are sentences that perform different roles.

Each paragraph in the body of an essay should contain:

1. A
topic sentence
(or main idea sentence) that states your point;

2. An
explanation
of the point you’re making; and

3.
Evidence
. Most of the time, your point should be supported by some form of evidence from your reading, or by an example drawn from the subject area.

Don’t just leave the evidence hanging there, you will need to analyse it! Comment on the implication/significance/impact, and finish off the paragraph with a critical conclusion you have drawn from the evidence.

GET A PLAGIARISM-FREE ESSAY HERE

Type of sentence Role within the paragraph

Topic introducer sentence
: Introduces the overall topic of the text (generally in the first paragraph).

Topic sentence
: Introduces a paragraph by identifying the topic of that paragraph.

Developer sentence
: Expands the topic by giving additional information.

Modulator sentence
: Acts as a linking sentence and is often introduced by a signpost word, moving to another aspect of the topic within the same paragraph

Transition/Terminator
: Concludes the discussion of a topic within a paragraph, but can also be used as a transition sentence, where it provides a link to the topic of the next paragraph.

The Five-Paragraph Essay (Academic Essay) structure

The five-paragraph essay usually comprises the introduction, three body paragraphs, and the conclusion.

INTRODUCTION PARAGRAPH

The first paragraph of a five-paragraph essay starts with a sentence that grasps the attention of the potential reader and introduces the essay. It is also in the first paragraph where the thesis statement is found. The
thesis statement
defines exactly what the essay is all about. The essay then transitions to the second paragraph. In summary, it does the following;

Arouse the reader’s interest

• Set the scene and explain how you interpret the question set

• The thesis statement identifies the issues that you are going to explore

• Give a brief outline of how you will deal with each issue

BODY PARAGRAPHS

The second paragraph of a
five-paragraph essay
starts with the first point in support of the thesis. This should be the strongest point in the essay. The introductory sentence is followed by a sentence giving evidence in support, and another to explain the evidence.  This is followed by the last sentence, which concludes the paragraph and then introduces the next paragraph of the five-paragraph essay. This procedure is repeated in the third and fourth paragraphs. This is to ensure that each paragraph has its own point which it supports.

Paragraph 1

Covers the first thing you said you would address. The first sentence (the topic sentence) introduces the main idea of the paragraph.

Other sentences develop the topic. Include examples, details, evidence, references etc.

Paragraph 2 and other paragraphs

The first sentence links the paragraph to the previous paragraph, then introduces the main idea of the paragraph

CONCLUSION PARAGRAPH

After the body paragraphs, the conclusion is written. This is the final paragraph which summarizes the entire essay, restates the thesis statement introduced in the first paragraph, and concludes the entire essay. No new point should be introduced at this stage.

Draw everything together.

• Summarize the main themes.

• State your general conclusions

• Make it clear why those conclusions are significant

•
Do not
introduce new material

• In the last sentence, sum up your argument very briefly, linking it to the title

• Set the issues in a broader perspective/wider context

NRNP 6552 Midterm Exam Walden University Question 15                                               1 pts

EBP stands for:

Group of answer choices

 

Experimental based practice

 

Evidence based practice

GET EXAM HELP HERE

Excellent bedside practice

 

None of
the above

NURS 6512 Week 7 I-HUMAN PATIENTS CASE STUDY: ASSESSING THE CARDIOVASCULAR SYSTEM

i-Human Case Week #7

56 y/o

5′ 5″ (165 cm)

188.0 lb (85.5 kg)

Reason for encounter

Blood pressure recheck

Location

Outpatient clinic with laboratory capabilities

CLICK HERE TO GET iHUMAN HELP 

Key Findings

Prior elevated blood pressure reading without diagnosis of HTN

Asymptomatic

High-fat, high-salt diet

Physical inactivity

PMH of hypothyroidism

Family history of heart disease

Denies polyuria, polydipsia, polyphagia

Vital signs within normal limits

Obese BMI

Xanthoma, arcus senilis

Remaining physical exam unremarkable

Medications/Allergies

Additional social history

ROS: Inquiry into constitutional symptoms

ROS: Inquiry into endocrine symptoms

ROS: Inquiry into gastrointestinal symptoms

ROS: Inquiry into respiratory symptoms

Communication: Elicit the patient’s perspective

 

Case: Problem Statement

This patient is a 56-year-old obese female with a PMH of hypothyroidism who presents for a blood pressure recheck after attending a workplace health fair 3 weeks ago (BP reading was 132/74). She is asymptomatic and reports consuming a high-fat, high-salt diet, physical inactivity, and a family history of heart disease. She denies polydipsia, polyuria polyphagia, chest pain, and shortness of breath. Physical exam shows stable vital signs with BP 118/72, bilateral eye xanthoma, and arcus senilis. The remaining physical exam is unremarkable

 

NURS 6512 Week 7 I-HUMAN PATIENTS CASE STUDY: ASSESSING THE CARDIOVASCULAR SYSTEM

I-HUMAN PATIENTS CASE STUDY: ASSESSING THE CARDIOVASCULAR SYSTEM

This course requires you to complete a series of case studies using the i-Human Patients software application. The i-Human Patients (IHP) Case Player enables you to interact with virtual patients for the purpose of learning patient-assessment and diagnostic-reasoning skills. With IHP, you will be able to independently interview, examine, diagnose, and treat virtual patients and receive expert feedback on your performance.

In order to adequately assess the chest region of a patient, advanced practice nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities.

Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack?

Resources

 

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

By Day 1 of this week, your Instructor will assign an i-Human Patients case for this Assignment. 
Note:
 Please see the 
Course Announcements
 section of the classroom for your i-Human Patients Assignment.

Review this week’s Learning Resources and consider the insights they provide related to the cardiovascular system.

Access and review the assigned i-Human Patients case study. Based on the provided patient information, think about the health history you would need to collect from the patient.

Consider what physical exams and diagnostic tests would be most appropriate to gather more information about the patient’s condition.

Reflect on how the results would be used to make a diagnosis.

NURS 6512 Week 7 I-HUMAN PATIENTS CASE STUDY: ASSESSING THE CARDIOVASCULAR SYSTEM

Identify 
three to five (3–5)
 possible conditions that may be considered in a differential diagnosis for the patient.

Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.

Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with cardiovascular conditions.

Assignment

As you interact with this week’s i-Human Patients patient, complete the assigned case study. For guidance on using i-Human Patients, refer to the 
i-Human Graduate Programs Help link
 within the i-Human Patients platform.

By Day 7 of Week 7

Upload
 your PDF from i-Human Patients to submit this Assignment.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
Start Here
 area.

To submit your completed assignment, save your Assignment as 
WK7Assgn_LastName_FirstInitial

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
 and select 
Submit Assignment
 for review.

Rubric

NURS_6512_Week 7_Assignment_Rubric

NURS_6512_Week 7_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
History: Complete an appropriate health history. (Scores are automatically calculated in the i-Human platform.)

20
 pts

Excellent

Achieves a score of 85–100%

15
 pts

Good

Achieves a score of 84–75%

10
 pts

Fair

Achieves a score of 74–65%

5
 pts

Poor

Achieves a score of 64–55%

0
 pts

Unsatisfactory

Achieves a score of 54% or below

20
 pts

This criterion is linked to a Learning Outcome
Physical Exam: Complete an appropriate physical exam. (Scores are automatically calculated in the i-Human platform.)

20
 pts

Excellent

Achieves a score of 85–100%

15
 pts

Good

Achieves a score of 84–75%

10
 pts

Fair

Achieves a score of 74–65%

5
 pts

Poor

Achieves a score of 64–55%

0
 pts

Unsatisfactory

Achieves a score of 54% or below

20
 pts

This criterion is linked to a Learning Outcome
EMR Documentation History of Present Illness: 5 criteria: 1.) Complete; 2.) Accurate; 3.) Written in Professional Language; 4.) Pertinent to the Chief Complaint; 5.) Includes Subjective findings only

10
 pts

Excellent

Complete HPI meeting all 5 criteria.

8
 pts

Good

4 requirements are met.

6
 pts

Fair

3 requirements are met.

4
 pts

Poor

1–2 requirements are met.

0
 pts

Unsatisfactory

No requirements are met.

10
 pts

This criterion is linked to a Learning Outcome
EMR Documentation Subjective Data Document Current Medications, Review of System: 5 criteria: 1.) Complete; 2.) Accurate; 3.) Written in Professional Language; 4.) Pertinent to the Chief Complaint; 5.) Includes Subjective findings only

10
 pts

Excellent

Complete HPI meeting all 5 criteria.

8
 pts

Good

4 requirements are met.

6
 pts

Fair

3 requirements are met.

4
 pts

Poor

1–2 requirements are met.

0
 pts

Unsatisfactory

No requirements are met.

10
 pts

This criterion is linked to a Learning Outcome
EMR Documentation Objective Data Document Physical Exam Findings: 5 criteria: 1.) Complete; 2.) Accurate; 3.) Written in Professional Language; 4.) Pertinent to the Chief Complaint; 5.) Includes Objective findings only

10
 pts

Excellent

Complete HPI meeting all 5 criteria.

8
 pts

Good

4 requirements are met.

6
 pts

Fair

3 requirements are met.

4
 pts

Poor

1–2 requirements are met.

0
 pts

Unsatisfactory

No requirements are met.

10
 pts

This criterion is linked to a Learning Outcome
Key Findings: Organize the key findings with the most important first and least important last. NURS 6512 Week 7 I-HUMAN PATIENTS CASE STUDY: ASSESSING THE CARDIOVASCULAR SYSTEM

5
 pts

Excellent

The key findings are complete and appropriately organized.

4
 pts

Good

The key findings are complete but the organization is not correct.

3
 pts

Fair

There are 1–2 key findings missing or organized inappropriately.

2
 pts

Poor

There are 3 key findings missing and organization is incorrect.

0
 pts

Unsatisfactory

There are more than 3 key findings missing and organization is incorrect.

5
 pts

This criterion is linked to a Learning Outcome
Problem Statement: Document a brief and accurate problem statement using professional language that includes the following: 1.) Name or initials, age; 2.) Chief complaint; 3.) Positive and negative subjective findings; 4.) Positive and negative objective findings.

5
 pts

Excellent

All requirements are met.

4
 pts

Good

3 requirements are met.

3
 pts

Fair

2 requirements are met.

2
 pts

Poor

1 requirement is met.

0
 pts

Unsatisfactory

No requirements are met.

5
 pts

This criterion is linked to a Learning Outcome
Management Plan: Use the expert diagnosis provided to create a pertinent, comprehensive, evidenced-based management plan. Address the following criteria in the plan: 1.) Diagnostic tests; 2.) Medications (write out a complete order, even for OTC meds); 3.) Suggested consults/referrals; 4.) Patient education; 5.) Follow-up, including time interval and specific symptoms to prompt a return visit sooner; 6.) Provide rationales for each intervention and include references to support your plan. Clinical practice guidelines should be utilized as applicable.

15
 pts

Excellent

All requirements are met.

13
 pts

Good

5 requirements are met.

10
 pts

Fair

4 requirements are met.

7
 pts

Poor

1-3 requirements are met.

0
 pts

Unsatisfactory

No requirements are met.

15
 pts

This criterion is linked to a Learning Outcome
References and Format: Current APA citations for references in management plan. Use of clinical practice guidelines when applicable.

5
 pts

Excellent

0–1 errors Clinical practice guidelines used when applicable.

4
 pts

Good

2–3 errors Clinical practice guidelines used when applicable.

3
 pts

Fair

4–5 errors Clinical practice guidelines not used when applicable.

2
 pts

Poor

6–7 errors Clinical practice guidelines not used when applicable.

0
 pts

Unsatisfactory

More than 7 errors; clinical practice guidelines not used when applicable.

5
 pts

Total Points: 
100 NURS 6512 Week 7 I-HUMAN PATIENTS CASE STUDY: ASSESSING THE CARDIOVASCULAR SYSTEM

Question 141 pts

The endometrial cycle has three phases, which are:

Group of answer choices

 

Proliferative, luteal, menstrual

 

Luteal, menstrual, post-menstrual

 

Proliferative, secretory, menstrual * (pg. 91)

 

Secretory, luteal, menstrual

 

 

NRNP 6552 Midterm Exam
Walden University