A 28-year-old woman is referred to the PMHNP for persistent insomnia and depression after being treated in the emergency department of her local hospital for headaches, stomach pain, and various other physical complaints five times in the past 6 months. Which findings on the mental status exam would lead the PMHNP to suspect intimate partner violence?
She is hyperactive, with flight of ideas and rapid speech.
She is withdrawn, frightened, and hypersensitive to touch.
She is defensive and angry.
She is disorganized in her thinking and her mood is labile.
The Correct Answer is B
Choice A reason: Hyperactivity, flight of ideas, and rapid speech are more indicative of manic or hypomanic states. These symptoms are not typically associated with intimate partner violence.
Choice B reason: Withdrawal, fearfulness, and hypersensitivity to touch are classic signs of trauma and abuse. These behaviors may reflect hypervigilance, fear of physical contact, and emotional distress, all of which are consistent with a history of intimate partner violence.
Choice C reason: Defensiveness and anger may be present in various psychiatric conditions, including personality disorders or trauma responses. However, they are not as specific or telling as the signs in choice B.
Choice D reason: Disorganized thinking and labile mood may suggest psychosis or mood disorders but are not specific indicators of intimate partner violence. They lack the trauma-related behavioral cues seen in choice B.
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Naxlex Comprehensive Predictor Exams
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Correct Answer is C
Explanation
Choice A reason: Cannabis dependence was a term used in earlier diagnostic frameworks such as DSM-IV. It has since been replaced by the broader and more clinically accurate term “cannabis use disorder” in DSM-5, which encompasses both abuse and dependence.
Choice B reason: Cannabis abuse disorder is also an outdated term from DSM-IV. DSM-5 integrates abuse and dependence into a single diagnosis—cannabis use disorder—based on severity and symptom criteria.
Choice C reason: Cannabis use disorder is the correct DSM-5 diagnosis. It includes patterns of problematic use leading to significant impairment or distress, such as continued use despite interpersonal problems, legal issues, and risky behaviors like driving under the influence. The patient’s daily use, denial of the problem, and conflict with his spouse meet criteria for this diagnosis.
Choice D reason: Unspecified cannabis-related disorder is used when symptoms are present but do not meet full criteria for a specific diagnosis. In this case, the patient clearly meets criteria for cannabis use disorder, making this option inappropriate.
Correct Answer is D
Explanation
Choice A reason: Denial involves refusing to acknowledge reality or emotions. In this case, the woman is aware of her anger but chooses not to express it directly, so denial does not apply.
Choice B reason: Sublimation is a defense mechanism where unacceptable impulses are transformed into socially acceptable actions. For example, channeling anger into exercise or art. Kicking a cat is not a socially acceptable outlet.
Choice C reason: Countertransference refers to a therapist’s emotional reaction to a client, often based on the therapist’s own unresolved issues. This concept does not apply to the woman’s personal reaction in a non-clinical setting.
Choice D reason: Displacement occurs when emotions are redirected from the original source to a safer or more acceptable target. The woman cannot express her anger at work, so she redirects it toward her cat, making this a textbook example of displacement.
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