nrnp6675 final exam 2022 latest all 100 answers

Question 1

Which of the following is consistent with current epidemiology literature about gender and Obsessive-Compulsive Disorder (OCD)?

 

A.           Adult men are more likely to have OCD than adult women.

 

B.           Adult women are more likely to have OCD than adult men.

 

C.           Adolescent girls are more likely to have OCD than adolescent boys.

 

D.           Adult men and adult women are equally likely to have OCD.

 

Question 2

Which of the following are keys to distinguishing OCD from psychosis?

 

A.           Patients with OCD can almost always acknowledge the unreasonable nature of their symptoms.

 

B.           Patients with OCD are better able to control their compulsions.

 

C.           Patients with psychosis will have more obsessive thoughts.

 

D.           Patients with OCD have less bizarre obsessions.

 

                            

3

Question 3

Variations from norms in gender role behavior such as toy preferences, rough-and-tumble play, aggression, or playmate gender in known as which of the following?

 

A.           Gender discordance

 

B.           Gender role behavior

 

C.           Gender identity variance

 

D.           Childhood gender non-conformity

 

Question 4

Symptoms of opioid intoxication include which of the following?

 

A.           Altered mood

 

B.           Psychomotor retardation

 

C.           Impaired memory

 

D.           All of the above

Question 5

Which of the following factors are associated with poor prognosis for patients with OCD?

 

A.           Childhood onset

 

B.           The presence of a precipitating event

 

C.           Co-existing major depressive disorder

 

D.           A and C

Question 6

Sexual stimuli or acts that are deviations from normal sexual behaviors but are necessary for some persons to experience arousal and orgasm are known as which of the following?

 

A.           Paraphilias

 

B.           Dyspareunium

 

C.           Orgasmic anhedonias

 

D.           Persistent genital arousal disorder

Question 7

Which of the following is true about the Global Assessment of Functioning (GAF)?

 

A.           The GAF is still an essential score in the DSM-5 diagnosis.

 

B.           The clinician-researchers at the APA do not believe that a single GAF score is adequate to assess all aspects of functioning.

 

C.           The clinician-researchers at the APA developing the DSM-5 recommend the GAF be used only by clinicians and researchers who have specific training to support good reliability of the GAF score.

 

D.           The GAF should only be used for patients who are suicidal.

Question 8

Which of the following tests for individuals with schizophrenia is substantially helpful in diagnosis and treatment planning?

 

A.           Rorschach test

 

B.           Thematic apperception test

 

C.           Minnesota Multiphasic Personality Inventory

 

D.           None or the above

Question 9

A patient with history of hypoglycemia reports feelings of fear, worry, and restlessness that has persisted over the past 6 months. The patient states these feelings are worse when glucose is low. The ARNP suspects the patient has which of the following diagnoses?

 

A.           Generalized anxiety disorder attributable to another medical condition

 

B.           Panic attacks attributable to another medication condition

 

C.           Hypoglycemia with anxiety

 

D.           None of the above

Question 10

A continuous or intermittent craving for the substance to avoid a dysphoric state is known as which of the following concepts related to substance use and addictive disorders?

 

A.           Addiction

 

B.           Physical dependence

 

C.           Behavioral dependence

 

D.           Psychological dependence

Question 11

Which of the following is consistent with what is known regarding metabolism of alcohol?

 

A.           About 90 percent of absorbed alcohol is metabolized through oxidation in the liver, the remaining 10 percent is excreted unchanged by the kidneys and lungs.

 

B.           About 70 percent of absorbed alcohol is metabolized in the liver, 20 percent metabolized and excreted through the kidneys.

 

C.           The body can metabolize 50 mg/dL or 40% alcohol per hour.

 

D.           Alcohol is metabolized by alcohol hydrogenase (ADH) and aldehyde hydrogenase.

Question 12

The symptoms of prolonged erection in the absence of sexual stimuli is known as which of the following?

 

A.           Priapism

 

B.           Arousal dysfunction

 

C.           Sustained orgasm

 

D.           Sexual dysfunction due to general medical condition

Question 13

Which of the following is consistent with current literature regarding positive and negative symptoms of schizophrenia?

 

A.           Negative symptoms occur earlier in the disease process; positive symptoms tend to decrease over time.

 

B.           Positive symptoms occur earlier in the disease process; negative symptoms tend to decrease over time.

 

C.           Positive and negative symptoms occur and vary simultaneously throughout the course of the disease.

 

D.           None of the above

Question 14

Fantasies and sexual urges to dress in opposite gender clothing as a means of arousal and as an adjunct to masturbation or coitus is known as which of the following?

 

A.           Fetishism

 

B.           Voyeurism

 

C.           Transvestism

 

D.           Scatologia

Question 15

A chronic disorder characterized by repetitive hair pulling, leading to variable hair loss that may be visible to others is known as which of the following?

 

A.           Obsessive-Compulsive Disorder

 

B.           Impulse Control Disorder

 

C.           Trichotillomania

 

D.           Factitious Dermatitis

Question 16

Which of the following is consistent with the epidemiology of schizophrenia in the United States?

 

              The lifetime prevalence of schizophrenia is about 50 percent.

 

              Schizophrenia is more prevalent in children than in adolescents.

 

              Peak age of onset in men is 10 to 25 years of age.

 

              Onset of schizophrenia before the age of 25 is extremely rare.

Question 17

The diagnosis used to describe a syndrome characterized by specific signs and symptoms resulting from recent ingestion or exposure to a substance is known as which of the following?

 

A.           Substance intoxication

 

B.           Substance withdrawal

 

C.           Substance use disorder

 

D.           Any of the above

Question 18

Preoccupation with an imagined defect in appearance that causes clinically significant distress or impairment in important areas of functioning is consistent with which of the following disorders?

 

A.           Anorexia

 

B.           Body Dysmorphic Disorder

 

C.           Obsessive-Compulsive Disorder

 

D.           Dissociative Disorder

Question 19

A patient presents with delusions, disorganized thoughts, and speech, with poor self-care, all of which have persisted for the past 7 months. The APRN realizes this presentation is consistent with which of the following diagnoses?

 

A.           Schizophrenia

 

B.           Schizophreniform disorder

 

C.           Brief psychotic disorder

 

D.           Delusional disorder

Question 20

Clinical findings that may indicate abuse include which of the following? Select all that apply.

 

A.           Delay between onset of injury and seeking treatment.

 

B.           Explanation by the patient which is inconsistent with the type of injury.

 

C.           Psychological distress such as depression, anxiety, suicidal ideations and/or sleep disorder.

 

D.           Explanation by the patient which is inconsistent with the type of injury.

Question 21

Which of the following patients would be appropriate for hospitalization for substance use disorder? Select all that apply.

 

A.           Patients who have a substance overdose who cannot be safely treated in an outpatient setting

 

B.           Patients who are at risk for severe or medically complicated withdrawal syndromes

 

C.           Patients who have a history of not benefiting from treatment in a less intensive setting

 

D.           A and B only

Question 22

Which of the following are risk factors for neuroleptic malignant syndrome? Select all that apply.

 

A.           Age

 

B.           Rapid dose escalation

 

C.           Parental route of administration

 

D.           Higher potency typical antipsychotics

Question 23

Which of the following physiological symptoms are consistent with hallucinogen use? Select all that apply.

 

A.           Sweating

 

B.           Palpitations

 

C.           Pupillary dilation

 

D.           None of the above

Question 24

Nsytagmus, or marked slurring of speech and blackouts, are likely impairments at which of the following blood alcohol concentrations?

 

A.           30 – 80 mg/dL

 

B.           80 – 200 mg/dL

 

C.           200 – 300 mg/dL

 

D.           300 – 400 mg/dL

Question 25

The fear of or anxiety regarding places from which escape might be difficult is known as which of the following?

 

A.           Depression

 

B.           Panic disorder

 

C.           Agoraphobia

 

D.           Generalized anxiety disorder

Question 26

Recurrent preoccupation with sexual urges and fantasies involving the act of being humiliated, beaten, bound, or otherwise made to suffer is known as which of the following?

 

A.           Frotteurism

 

B.           Sexual Sadism

 

C.           Sexual Masochism*

 

D.           Other Specified Paraphilic Disorder

Question 27

A recurrent intrusive thought, feeling, idea, or sensation that causes severe distress to the individual is known as which of the following?

 

A.           A compulsion

 

B.           An obsession

 

C.           A specific phobia

 

D.           Normal

Question 28

Phencyclidine (PCP) and Ketamine exert their unique behavioral effects by blocking which of the following receptors?

 

A.           GABA type receptors

 

B.           Serotonin receptors

 

C.           Dopamine receptors

 

D.           NMDA type receptors

Question 29

Individuals with posttraumatic stress disorder show symptoms in which of the following domains?

 

A.           Intrusion symptoms

 

B.           Symptoms of avoidance

 

C.           Increased autonomic arousal

 

D.           All of the above

uestion 30

A diffuse, unpleasant, vague sense of apprehension, often accompanied by autonomic symptoms which varies among persons is commonly known as which of the following?

 

A.           Fear

 

B.           Stress

 

C.           Normal anxiety

 

D.           Pathological anxiety

Question 31

Testosterone increases libido in which of the following?

 

A.           Testosterone increases libido in men.

 

B.           Testosterone increases libido in women

 

C.           Testosterone increases libido in men and women.

 

D.           Testosterone effects male characteristics but is not instrumental in libido.

Question 32

Which of the following is consistent with what is known about the epidemiology of anxiety?

 

A.           Men have a higher lifetime prevalence of anxiety than women.

 

B.           Women have a higher lifetime prevalence of anxiety than men.

 

C.           Men and women have equal lifetime prevalence.

 

D.           The lifetime prevalence of anxiety is not gender specific.

Question 33

Because the DSM-V and ICD disorders names may not match, the ARNP should document which of the following?

 

A.           The DSM-V diagnosis is all that is required, so if there is not a match the ICD code is not needed.

 

B.           As the ICD code is what is used for billing, this is the only documentation required.

 

C.           The DSM-V diagnosis should always be recorded by name in the medical record in addition to listing the ICD code.

 

D.           Document the DSM-V code and several ICD codes so the insurer cannot deny the claim.

Question 34

A condition in which an enzymatic defect in the production of adrenal cortisol, beginning prenatally, leads to overproduction of adrenal androgens and, when the chromosomes are XX, virilization of the female fetus, is known as which of the following?

 

A.           Congenital adrenal hyperplasia

 

B.           Androgen insensitivity syndrome

 

C.           Turner’s syndrome

 

D.           5-α-reductase deficiency

Question 35

A patient who presents absent movement, with difficulty starting activities, flat affect, and avolition would be assessed as having which of the following?

 

A.           Dystonia

 

B.           Akathisia

 

C.           Akinesia

 

D.           Pseudo-Parkinson’s

Question 35

A patient who presents absent movement, with difficulty starting activities, flat affect, and avolition would be assessed as having which of the following?

 

A.           Dystonia

 

B.           Akathisia

 

C.           Akinesia

 

D.           Pseudo-Parkinson’s

uestion 37

Which of the following is a system that provides a uniform language for describing medical and surgical procedures and diagnostic services rendered by clinicians?

 

A.           HIPPA

 

B.           DSM-5

 

C.           CPT

 

D.           DRG

Question 38

Usually characterized by a man’s rubbing his penis against the buttocks or other body parts of a fully clothed woman to achieve orgasm is known as which of the following?

 

A.           Voyeurism

 

B.           Fetishism

 

C.           Frotteurism

 

D.           Partialism

Question 39

A patient with a substance abuse disorder who does not meet the clinical criteria for hospitalization but who lacks sufficient social and vocational skills and lack substance-free social supports, is appropriate for which of the following levels of treatment?

 

A.           Residential treatment

 

B.           Partial hospitalizations

 

C.           Outpatient treatment

 

D.           All of the above

Question 40

A condition which results from absence of second female sex chromosome (XO) and is associated with web neck, dwarfism, cubitus valgus, and infertility in known as which of the following?

 

A.           Hermaphroditism

 

B.           Turner’s syndrome

 

C.           Adrenogenital syndrome

 

D.           Androgen insensitivity syndrome

Question 41

Billing responsibilities related to Medicare providers include which of the following?

 

A.           Collecting patient employment and insurance information

 

B.           Identifying payers other than Medicare

 

C.           Determining if Medicare is a primary or secondary provider

 

D.           All of the above

Question 42

Which of the following is not consistent with benzodiazepine withdrawal?

 

A.           Benzodiazepine withdrawal can continue to develop for several weeks.

 

B.           The best way to proceed with benzodiazepine withdrawal is to stop it immediately and treat withdrawal symptoms.

 

C.           It may be helpful to switch to a long-acting benzodiazepine for withdrawal.

 

D.           If patient is on a therapeutic benzodiazepine dose, initiate 10–25 percent dose reduction and evaluate response.

Question 43

In which ways are nurse practitioners (NPs) and physician’s assistants (PAs) different?

 

A.           NPs differ from PAs in legal definition, scope of practice, licensure, and independence of practice.

 

B.           NPs practice under their own license and independent of the physician, PAs always work under the supervision of a physician.

 

C.           There is essentially no difference functionally between an NP and a PA.

 

D.           A and B

 

 

1 points  

Question 44

Antipsychotic medications provide D2 blockade in the mesolimbic system which results in which of the following?

 

A.           Decrease positive symptoms

 

B.           Reduce positive symptoms

 

C.           Increase extrapyramidal symptoms (EPS)

 

D.           Decrease extrapyramidal symptoms (EPS)

Question 45

Methadone withdrawal usually begins how soon after the last dose?

 

A.           6–8 hours after the last dose

 

B.           8–12 hours after the last dose

 

C.           24 hours after the last dose

 

D.           1–3 days after the last dose

Question 46

Which of the following symptoms would suggest an underlying medical issue in a patient experiencing panic-like symptoms?

 

A.           Ataxia

 

B.           Nausea

 

C.           Sweating

 

D.           Palpitations

 

Question 61

Which of the following is not a common physical effect of cannabis?

 

A.           Mild tachycardia

 

B.           Mild bradycardia

 

C.           Orthostatic hypotension

 

D.           Dilation of the conjunctival blood vessels

Question 62

A patient on chlorpromazine states that his orgasm is dry and afterward he will commonly have milky urine. The ARNP realizes which of the following?

 

A.           This is likely a harmless response to the chlorpromazine.

 

B.           This is abnormal and needs to be evaluated by a specialist.

 

C.           It is critical to stop the Chlorpromazine immediately.

 

D.           This has nothing to do with the chlorpromazine the patient should be referred to his PCP for follow-up.

Question 63

A term used to designate the behavioral patterns of family members who have been significantly affected by another family member’s substance use or addiction is which of the following?

 

A.           Denial

 

B.           Enabling

 

C.           Codependence

 

D.           Enmeshment

Question 64

Genital play in infants is considered which of the following?

 

A.           A sign of abuse

 

B.           A part of normal development

 

C.           Rarely ever seen

 

D.           An early sign of abnormal sexual development

Question 65

The recurrent and intense sexual arousal from the physical and psychological suffering of another person is known as which of the following?

 

A.           Frotteurism

 

B.           Voyeurism

 

C.           Sexual sadism

 

D.           Sexual masochism

Question 66

A federal program administered nationally and locally which covers enrolled individuals 65 years and older who pay premiums and disabled individuals who qualify for Social Security disability payments and benefits is

 

A.           Medicare

 

B.           Medicaid

 

C.           Both A and B

 

D.           None of the above

Question 67

The phenomenon in which, after repeated administration, a given dose of drug produces a decreased effect is known as which of the following?

 

A.           Tolerance

 

B.           Cross-tolerance

 

C.           Addiction

 

D.           Intoxication

Question 68

As a Medicare Part B provider, you should do which of the following?

 

A.           Obtain billing information at the time service is rendered.

 

B.           Obtain payment at the time service is rendered.

 

C.           Submit an explanation of benefits (EOB) form with all appropriate MSP information to the designated carrier.

 

D.           A and C only

uestion 69

Activities, interests, use of symbols, styles, or other personal and social attributes that are recognized as masculine or feminine is known as which of the following?

 

A.           Gender identity

 

B.           Gender role behavior

 

C.           Gender discordance

 

D.           Internalizes sexual prejudice

Question 70

Having an adequate legal description of nurse practitioner (NP) scope of practice according to state law is important for which of the following reasons?

 

A.           To avoid any charges of practicing medicine without a license.

 

B.           To place accountability for both benefits and harm to patients squarely on the NP.

 

C.           To get reimbursement for physician services when provided by and NP.

 

D.           All the above.

Question 71

Which of the following is not true about reimbursement from third party payers?

 

A.           Each type of third-party payer has its own reimbursement policies and fee schedules.

 

B.           Each type of third-party payer operates under a separate body of law.

 

C.           Not every third-party payer will pay every NP for every service.

 

D.           All third-party payers must reimburse NPs in the same manner that they reimburse physicians.

Question 72

Most everyone has a firm conviction that they are male or female by which age range?

 

A.           0–1 years of age

 

B.           2–3 years of age

 

C.           4–5 years of age

 

D.           6–7 years of age

Question 73

Which of the following is consistent with NP practice parameters when prescribing buprenorphine?

 

A.           NPs with full practice authority can prescribe and administer buprenorphine under their state NP license.

 

B.           As a qualified practitioner the NP simply needs to notify SAMHSA prior to prescribing or administering buprenorphine.

 

C.           The NP can provide buprenorphine to 300 patients per month.

 

D.           The NP is required to complete specific training to prescribe and dispense buprenorphine.

Question 74

The genotype XXY is associated with which of the following?

 

A.           Klinefelter’s syndrome

 

B.           Androgen insensitivity syndrome

 

C.           Turner’s syndrome

 

D.           Adrenogenital syndrome

Question 75

All of the following are one of the five major categories of third-party payers EXCEPT:

 

A.           Medicare/Medicaid

 

B.           Managed-care organizations (MCOs)

 

C.           Indemnity insurance companies

 

D.           Only A and B

Question 76

Which of the following initials would a psychiatric-mental health nurse practitioner use to designate appropriate credentials?

 

A.           ANP-C

 

B.           CPNP

 

C.           CPNP-AC

 

D.           PMHNP-BC

Question 77

Which of the following is true about preoccupation with castration?

 

A.           This can be serious and life-threatening if castration is carried out without medical supervision.

 

B.           This is consistent with Transvestic Disorder.

 

C.           This is consistent with other specified paraphilic disorder.

 

D.           This is consistent with sexual masochism disorder.

Question 78

When a manic or depressive syndrome develops concurrently with the major symptoms of schizophrenia, the appropriate diagnosis would be which of the following?

 

A.           Bipolar schizophrenia

 

B.           Mood disorder with psychosis

 

C.           Schizoaffective disorder

 

D.           Bipolar disorder with psychosis

Question 79

Which of the following neurotransmitters increases libido?

 

A.           GABA

 

B.           Serotonin

 

C.           Oxytocin

 

D.           Dopamine

Question 80

Which of the following should be considered when prescribing medications? Check all that apply.

 

A.           Can the patient afford the medication?

 

B.           Is the drug available at the hospital or at a local pharmacy?

 

C.           Can the patient read?

 

D.           Is there potential for abuse?

Question 81

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was developed for which of the following purposes?

 

A.           To facilitate a seamless transition into immediate use by clinicians and insurers to maintain continuity of care

 

B.           To facilitate more precisely identifying and diagnosing mental disorders

 

C.           To eliminate need for ICD-9 codes

 

D.           A and B

Question 82

A rare life-threatening condition that can occur at any time in a patient receiving antipsychotic medication with symptoms which include increased creatinine phosphokinase, leukocytosis, hyperthermia, and tachycardia in known as which of the following?

 

A.           Tardive dyskinesia

 

B.           Pseudo-Parkinson’s

 

C.           Neuroleptic malignant syndrome

 

D.           Extrapyramidal side effects

Question 83

An excessive anxiety and worry about several events or activities for most days during at least a 6 month period is known as which of the following?

 

A.           Specific phobia

 

B.           Social anxiety disorder

 

C.           Anxiety personality disorder

 

D.           Generalized anxiety disorder

Question 84

If a pregnancy begins while the woman is taking high doses of methadone and withdrawal is desired, during which trimester is this least hazardous?

 

A.           First trimester

 

B.           Second trimester

 

C.           Third trimester

 

D.           Withdrawal from methadone should never be done while the woman is pregnant.

Question 85

Which of the following symptoms represent peripheral manifestations of anxiety?

 

A.           Hyperreflexia

 

B.           Palpitations

 

C.           Hyperhidrosis

 

D.           All of the above

Question 86

Recurrent, persistent genital pain occurring before, during, or after intercourse is known as which of the following?

 

A.           Vaginismus

 

B.           Dyspareunia

 

C.           Female orgasmic disorder

 

D.           Female sexual interest/arousal disorder

Question 87

Antipsychotic medications provide D2 blockade in the mesocortical pathway causing which of the following effects?

 

A.           Reduces negative symptoms

 

B.           Increases extrapyramidal symptoms (EPS)

 

C.           Causes prolactinemia

 

D.           Reduces positive symptoms

Question 88

A period of at least 6 months of recurrent and intense sexual arousal from cross-dressing that causes clinically significant distress or impairment is consistent with which of the following?

 

A.           Gender dysphoria

 

B.           Turner’s syndrome

 

C.           Transvestic Disorder

 

D.           Klinefelter’s syndrome

Question 89

Data indicate which of the following regarding women drinking while pregnant or breast feeding?

 

A.           Women who are pregnant or are breast-feeding should not drink alcohol.

 

B.           Women who are pregnant should not drink alcohol but drinking alcohol while breast-feeding is not a risk to the baby.

 

C.           Women who are pregnant or breast-feeding can drink one alcoholic drink up to 3 times per week without concern for risk to the fetus or baby.

 

D.           Women who are pregnant or breastfeeding can safely drink occasionally without risk to the fetus.

Question 90

Which of the following behaviors are associated with an alcohol blood level of 0.05 percent?

 

A.           Voluntary motor actions usually become perceptibly clumsy.

 

B.           Thought, judgment, and restraint are impaired.

 

C.           Confusion, stupor

 

D.           None of the above

Question 91

A psychotic disorder lasting more than a month but less than 6 months is known as which of the following?

 

A.           Brief psychotic disorder

 

B.           Schizophreniform disorder

 

C.           Psychotic depression

 

D.           Schizotypal personality disorder

Question 92

Obsessive -Compulsive Disorder is associated with dysregulation of which of the following neurotransmitters?

 

A.           Dopamine

 

B.           Serotonin

 

C.           Norepinephrine

 

D.           GABA

Question 93

The three major neurotransmitters associated with anxiety, based on animal studies and response to drug treatment, include which of the following?

 

A.           Glutamate, Norepinephrine, Serotonin

 

B.           GABA, Norepinephrine, Serotonin

 

C.           GABA, Dopamine, Glutamate

 

D.           Dopamine, Norepinephrine, Serotonin

Question 94

Telepsychiatrists adjust clinical care in which of the following ways to make it as personal as in- person care?

 

A.           Use fewer physical gestures as patients are not able to clearly appreciate them anyway.

 

B.           Check in with the patient to see how the patient is experiencing telepsychiatry.

 

C.           Insist every other appointment is an in-person appointment.

 

D.           Send things to the patient such as a box of tissues to facilitate the patient feeling cared for.

Question 95

Which of the following services are usually excluded from both primary and secondary Medicare benefits?

 

A.           Medicare does not reimburse for the same services covered by VA benefits.

 

B.           Medicare does not reimburse for services covered under the Federal Black Lung program.

 

C.           Medicare does not reimburse for services related to workers compensation.

 

D.           A and B only

Question 96

In the DSM-V the need for treatment is based on assessment of diagnosis and which of the following?

 

A.           Severity of symptoms

 

B.           Dangerous to self or others

 

C.           Disability in social and self-care spheres

 

D.           All of the above

Question 97

Which of the following genotypes is consistent with being identified as genetically male?

 

A.           XX

 

B.           XY

 

C.           XA

 

D.           XM

Question 98

A disorder characterized by acquiring and not discarding things that are deemed to be of little or no value, resulting in excessive clutter of living spaces is

 

A.           Specific Phobia

 

B.           Trichotillomania

 

C.           Hoarding Disorder

 

D.           Obsessive-Compulsive Disorder

uestion 99

Which of the following neurotransmitters exerts an inhibitory effect of sexual function?

 

A.           Dopamine

 

B.           Oxytocin

 

C.           Serotonin

 

D.           Glutamate

Question 100

Which of the following are consistent with current data related to the prevalence of drinking alcohol?

 

A.           Men and women with higher education and income are less likely to drink alcohol.

 

B.           Men and women with higher education and income are more likely to drink alcohol.

 

C.           Men and women with lower education and higher income are more likely to drink alcohol.

 

D.           Education and income are not a factor in prevalence of drinking alcohol.