PMHNP Questions

A 12-year-old boy is brought to the PMHNP because his mother says the boy is driving her "nuts." She reports that he constantly argues with her and his father, does not follow any of the house rules, and incessantly teases his sister. She says that he is spiteful and vindictive and loses his temper easily. Once he is mad, he stays that way for long periods of time. The mother notes that the boy started this behavior only about 1 year previously. While she states that this behavior started at home, it has now spread to school, where his grades are dropping because he refuses to participate. The patient maintains that none of this is his fault-his parents are simply being unreasonable. He denies feeling depressed and notes that he sleeps well through the night. Which of the following is the most likely diagnosis? 1. Oppositional defiant disorder 2. Antisocial personality disorder 3. Conduct disorder 4. Intermittent Exp

1

A 28-year-old patient presents with recurrent and intense episodes of fear and anxiety in response to specific triggers, such as crowded places and public speaking engagements. They report experieneing physical symptoms during these episodes, including rapid heart rate, sweating, and trembling. Additionally, the patient mentions that they often avoid situations that may trigger these reactions. Which brain structure is most likely implicated in the patient's fear and anxiety responses? 1. Amygdala 2. Frontal Lobe 3. Thalamus 4. Hippocampus

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A 32-year-old patient presents with symptoms of extreme thirst, excessive urination, problems with sleep rest cycles, circadian rhythms, changes in libido, and unexplained weight loss over the past few weeks. They report feeling constantly hungry and fatigued. A review of their medical history reveals no previous diagnoses of diabetes or other endocrine disorders. The PMHNP suspects a hormonal imbalance. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? 1. Hypothalamus 2. Amygdala 3. Hippocampus 4. Thalamus

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A 35-year-old patient, diagnosed with bipolar disorder, discloses to the PMHNP a history of violent outbursts during manic episodes. The patient expresses concern about potential harm to family members during the next manic episode. What is the PMHNP's most appropriate action based on the Tarasoff principle? 1. Inform the family members about the patient's history and potential for harm. 2. Document the patient's history but respect their confidentiality as there is no immediate plan for harm. 3. Adjust the patient's medication to prevent future manic episodes and associated violence. 4. Encourage the patient to attend anger management classes to address violent outbursts.

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A 38-year-old patient presents with changes in personality, difficulty in making decisions, and impaired social and occupational functioning. They have also been experiencing a loss of inhibitions and impulsivity. During the evaluation, you notice deficits in executive functions such as planning and problem-solving. Which brain region is most likely implicated in these symptoms? 1. Frontal Lobe 2. Occipital Lobe 3. Temporal Lobe 4. Parietal Lobe

1

A 43-year-old man is admitted to the neurology service after he went blind suddenly on the morning of admission. The patient does not seem overly concerned with his sudden lack of vision. The only time he gets upset during the interview is when he is discussing his mother's recent death in Cameroon-he was supposed to bring his mother to the United States but did not because he had been using drugs and did not save the necessary money. Physical examination is completely negative. Which of the following is the most likely diagnosis? 1. Conversion disorder 2. Adjustment disorder 3. MDD 4. Hypochondriasis

1

A 55-year-old patient with generalized anxiety disorder arrives at your clinic for her weekly therapy appointment. You have been counseling her for the past year. Today, she appears unusually gloomy, and her eyes are bloodshot as if she had just been crying. She tells you that she is worried that she will never get better, and she will always feel this way. As the nurse practitioner, you understand that this patient has negative distorted beliefs about herself and her illness. What individual therapy method is most appropriate to use in helping this client through her current crisis? 1. Cognitive Behavioral Therapy 2. Eye movement desensitization and reprocessing (EMDR) 3. Dialectical behavioral therapy (DBT) 4. Existential therapy

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A PMHNP is working in an outpatient pediatric clinic. Sarah's parents have brought her for an evaluation due to concerns about her behavior. She is an 8-year-old girl who frequently exhibits symptoms such as difficulty paying attention, forgetfulness, impulsivity, and frequent restlessness. What is her most likely diagnosis? 1. Attention-Deficit/Hyperactivity Disorder (ADHD) 2. Conduct Disorder 3. Generalized Anxiety Disorder (GAD) 4. Autism Spectrum Disorder (ASD)

1

A PMHNP recognizes that a number of his or her colleagues are prescribing a certain medication for an off-label use. The PMHNP's initial action is to: 1. Conduct a literature search to determine whether data support the off-label use. 2. Contact the pharmaceutical manufacturer to request related research findings. 3. Prescribe the medication for off-label use. 4. Report the colleagues to the state Board of Nursing.

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During a structural therapy session, the psychiatric-mental health nurse practitioner requests that the family improvise a play about their interrelationships. The nurse practitioner uses this method as a component of structural therapy to: 1. Map, track and modify the family structure. 2. Develop rigid boundaries and hierarchies. 3. Track family progress towards desired goals. 4. Distract family members from interpersonal problems.

1

In a quality assurance program, a retrospective audit involves: 1. Examining the charts of discharged patients and using specific criteria to determine the quality of patient care. 2. Inspecting the facility to monitor the therapeutic quality of the environment and to suggest improvements. 3. Reviewing patient charts to determine how appropriately hospital resources are being used. 4. Using a case conference format for staff to discuss ways to improve a particular patient's care.

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Sam, a six-year-old female presents with her mother for a new psychiatric evaluation. Her mother reports that Sam is not making friends at school, stays by herself, will not read aloud in class, and requests adult reassurance before making decisions. Which stage of Erikson's stages of development is Sam having difficulty mastering? 1. Industry versus Inferiority 2. Intimacy versus Isolation 3. Identity versus Role Confusion 4. Trust versus Mistrust

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The evidence hierarchy ranks sources of knowledge according to the strength of information they provide. Which of the following would you find in Level 1 of an evidence hierarchy? 1. Meta-Analysis 2. Cohort studies 3. Opinions of expert committees 4. Case control

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The members of a second-generation family of Mediterranean ancestry express concern about their immigrant grandmother's behavior. She persists in wearing heavy black clothing, secludes herself from the family, and prays throughout the day. Although she has no known health problems and appears to be healthy, she frequently discusses her impending death. The PMHNP assesses the grandmother based on the knowledge that: 1. Cultural factors may negate the significance of seemingly obvious symptoms. 2. She is exhibiting the classic signs of bipolar disorder. 3. She is exhibiting the classic signs of a major depressive disorder. 4. Suicide is common among older adults.

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Which behavior reflects existentially oriented therapy? 1. Attempting to understand a patient's subjective world 2. Challenging a patient's irrational beliefs 3. Focus on self-directed growth and self-actualization 4. Establishing general group goals

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Which mood stabilizer is associated with potential life-threatening rash in the Asian population? 1. Carbamazepine (Tegretol) 2. Depakote 3. Lithium 4. Lamictal

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Working with a 48-year-old patient recently diagnosed with schizophrenia and working using a recovery model: 1. Focus on his feelings, interests, and dreams. 2. Assist finding a job 3. Focus on side effects of medications 4. Psychoeducation

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A 19-year-old college student comes to the psychiatric mental health nurse practitioner (PMHNP) seeking treatment for symptoms of depression. During the assessment, the patient reveals a history of substance use and experimentation with illicit drugs. The patient expresses concern about the confidentiality of this information. What is the appropriate response regarding confidentiality for the psychiatric mental health nurse practitioner (PMHNP)? 1. Reassure the patient that all information will remain confidential without exception. 2. Inform the patient that confidentiality can be maintained unless there is a risk of harm to self or others. 3. Disclose to the patient that information about substance use will be shared with the college administration. 4. Guarantee complete confidentiality and promise not to disclose any information to anyone.

2

A 2-year-old baby is displaying low self-esteem, poor self-control, self-doubt, and a high level of dependency. These behaviors indicate developmental failure of which of the following stages of development: 1. Infancy 2. Early childhood 3. Late childhood 4. School age

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A 35-year-old male patient with a history of bipolar disorder presents to your psychiatric clinic in a highly agitated state. He reports feeling extremely elated, racing thoughts, and a decreased need for sleep for the past week. He also mentions experiencing auditory hallucinations commanding him to "take action." Which nursing action by the PMHNP would be of highest priority initially? 1. Assess his coping behaviors. 2. Assess his current level of suicidality. 3. Take his vital signs. 4. Assess his health history.

2

A 38-year-old woman quits her high-paying marketing job to focus on her children and become a school counselor. What stage would Erikson consider this to be: 1. Identity vs. Role Confusion 2. Generativity vs. Stagnation 3. Ego Integrity vs. Despair 4. Industry vs. Inferiority

2

A 45-year-old patient with schizophrenia is stabilized on Quetiapine (Seroquel) for antipsychotic treatment. The patient smokes heavily, and you are considering adjustments to the medication regimen. What is an important consideration regarding the effects of smoking on Quetiapine? 1. Smoking has no significant impact on the effectiveness or metabolism of quetiapine, and the patient can continue smoking without concerns. 2. Smoking may increase the metabolism of Quetiapine, potentially reducing its effectiveness, and close monitoring is required. 3. Smoking can enhance the antipsychotic effects of Quetiapine, allowing for a lower dose to be prescribed. 4. The patient should be advised to quit smoking immediately to avoid potential interactions with Quetiapine.

2

A 46-year-old male with a history of bipolar disorder comes for a regular follow-up appointment with a PMHNP and presents with complaints of severe vomiting, diarrhea, muscle weakness, blurred vision, and ataxia. The patient is currently taking 900mg of Lithium daily. The Psychiatric nurse practitioner identifies these symptoms as signs of Lithium toxicity. What is the priority action of the PMHNP? 1. Maintains medication regimen and monitors the symptoms. 2. Tells the patient to stop taking Lithium and orders a serum Lithium level. 3. Order an electrocardiogram. 4. Take the patient's vital signs.

2

A PMHNP is committed to reducing the stigma associated with mental illness in their community. What are the most effective avenues for the PMHNP to undertake in order to achieve this goal? 1. Conducting individual psychoeducation sessions for patients diagnosed with mental illnesses. 2. Hosting community workshops and awareness campaigns on mental health topics. 3. Advocating for changes in mental health legislation and policy at the state level. 4. Writing research articles on the prevalence of mental illness in academic journals.

2

A PMHNP is teaching a group of nursing students about the importance of formulating research questions in evidence-based practice. One student asks, "What does PICOT stand for?" Which of the following responses accurately represents the meaning of PICOT? 1. PICOT stands for "Patients, Interventions, Clinical Outcomes, Timeframes." It is an acronym used in nursing research to define research questions related to patient care." 2. PICOT stands for "Problem, Intervention, Comparison, Outcome, Timeframe." It is an acronym used in evidence-based practice to structure research questions and guide the search for evidence." 3. PICOT stands for "Population, Investigation, Comparison, Observation, Timeframe." It is an acronym used in healthcare research to summarize the key components of a research study." 4. PICOT stands for "Plan, Implement, Collect, Organize, Test." It is an acronym used in clinical practice to outline the

2

A PMHNP is working in a community mental health center. A 45-year-old male patient with a history of schizophrenia presents for a routine follow-up appointment. He has been stable on his current antipsychotic medication for the past six months and reports no significant side effects. During the appointment, he expresses his desire to discontinue his medication because he believes he no longer needs it, and that the medication has harmful effects on his body. He states that he wants to try managing his symptoms without medication. What is the most appropriate action of the PMHNP in this situation? 1. Respect the patient's autonomy and decision to discontinue medication and provide education on potential risks. 2. Engage in a collaborative discussion with the patient about the risks and benefits of medication, explore his concerns, and consider adjusting the treatment plan if appropriate. 3. Advise the patient to immed

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A PMHNP notices that few substance abuse treatment programs apply evidence-based practice. The PMHNP wants to initiate such a treatment program to: 1. Implement the use of valid instruments. 2. Improve outcomes through analysis and synthesis of evidence. 3. Maximize interventions and increase skill utilization. 4. Optimize revenue-generating potential.

2

A male patient informs an adult psychiatric and mental health nurse practitioner that he has not slept in three days, has poor concentration, and denies fatigue. The patient presents with rapid speech, irritability, self-inflated esteem, and is uncooperative during assessment. What is the patient's most likely diagnosis: 1. Antisocial personality disorder 2. Bipolar disorder 3. Panic disorder 4. Attention deficit hyperactivity disorder

2

A married couple of 7 years presents for therapy because the wife perceives her husband to be a constant nag. He believes that he is correct and only trying to help. You assign him a paradoxical directive to schedule 1 hour per day in which he nags her, and once that hour is over to keep a list and save it until the next day. The PMHNP recognizes this type of therapy as: 1. Existential therapy 2. Strategic therapy 3. Structural therapy 4. Solution-focused therapy

2

A middle-school boy repeatedly lies, steals, bullies peers, intigates fights, and inflicts harm without feeling any regret or remorse. These are characteristics of: 1. Oppositional defiant disorder 2. Conduct disorder 3. Disruptive mood dysregulation disorder 4. Antisocial personality disorder

2

A new prescription of carbamazepine (Tegretol) is given to a patient whose baseline white blood cell (WBC) count is 5000/uL and absolute neutrophil count (ANC) is 4000/uL. Laboratory tests show that the patient's WBC count has decreased to 2500/uL and ANC has decreased to 750/uL after two weeks of therapy. Similar outcomes are obtained when the laboratory studies are repeated. The patient does not present with any signs of infection. What is the next action of the PMHNP? 1. Continues the patient on Tegretol and monitors the patient for signs of infection 2. Tells the patient to stop taking Tegretol and recheck the ANC and WBC 3. Continues the patient on Tegretol since the WBC is within normal limits. 4. Refer the patient to a primary care provider

2

A patient presenting with auditory hallucinations, delusions, disorganized speech, and a disorganized behavior is most likely experiencing hyperactivity in which of the following brain pathways, and what would be the most appropriate phariaacological intervention? 1. The nigrostriatal pathway; administration of a selective serotonin reuptake inhibitor (SSRI). 2. The mesolimbic pathway; administration of a D2 receptor antagonist. 3. The tuberoinfundibular pathway; administration of a beta-blocker. 4. The mesocortical pathway; administration of a dopamine precursor.

2

A patient with anorexia nervosa is undergoing cognitive- behavioral therapy (CBT). A primary goal of the therapy for this patient will be: 1. Resolving symptoms of depression. 2. Overcoming distorted thinking. 3. Support weight gain 4. Improving interpersonal relationships.

2

A patient with borderline personality disorder experiences intense anxiety when an adult psychiatric and mental health nurse practitioner goes on vacation. The best explanation for this reaction is that the patient: 1. The patient is developing transference 2. has failed to master object constancy 3. is employing primitive idealization 4. is employing devaluation.

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A psychiatric mental health nurse practitioner (PMHNP) is conducting an evaluation on a 7-year-old child, Emma, who has been referred to an outpatient clinic due to concerns about her behavior and attention span. Her parents report that she frequently loses her belongings, has difficulty staying seated in class, struggles to complete schoolwork, and often interrupts others during conversations. They have also noticed that these symptoms have been present for at least six months. What is the next action of the PMHNP? 1. Initiate ADHD diagnosis based on parent reports and school observations. 2. Conduct a thorough psychiatric evaluation to rule out other possible causes of her symptoms. 3. Prescribe a low-dose stimulant medication to see if there is a positive response. 4. Refer Emma for psychotherapy without further assessment.

2

Any court of law that evaluates the standards of care provided by the psychiatric-mental health nurse practitioner: 1. compares the actions to the standard of care provided by a psychiatrist. 2. considers what a reasonably prudent PMHNP would do in the same or similar circumstance. 3. evaluates patient satisfaction data. 4. reviews the nurse practitioner's charts for similar patients.

2

Emily, a 35-year-old with bipolar disorder, expresses a desire to reduce her reliance on medication. What response is most consistent with the recovery model? 1. "It is crucial to maintain your current medication regimen for stability." 2. "Let's explore your reasons for wanting to reduce medication and develop a plan together." 3. "You should follow the prescribed medication plan without questioning it." 4. "Reducing medication is not a viable option at this time."

2

Following a series of reported medication errors in a psychiatric hospital, the PMHNP is implementing strategies to foster a just culture. What action promotes a just culture in this context? 1. Implementing a punitive system to deter future errors. 2. Encouraging a blame-free environment and promoting learning from errors. 3. Ignoring the reported errors to avoid negative consequences. 4. Terminating individuals involved in the reported errors.

2

The PMHNP has a law Bill in the senate legislature passed so that funds will be released to be used for housing the severe and persistently mentally ill. The PMHNP contacts eight persons and asks them to telephone the State Senate who heads the HHS committee, she asks them to tell the State Senator to vote to approve the bill. The NP is acting as an? 1. Care provider 2. Advocate 3. Policy maker 4. Stigma Reduction Agent

2

The anatomical structure of the limbic system that is associated with a reaction to stress is the: 1. Cerebellum 2. Hippocampus 3. Thalamus 4. Hypothalamus

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The parent or legal guardian of a seven-year-old child must approve any medication orders, because a child of this age fails to meet which two of the five elements of informed consent? 1. Autonomy and veracity 2. Decision capacity and comprehension 3. Confidentiality and beneficence 4. Disclosure of information and voluntariness

2

Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated with clozapine? 1. 2D6 2. 1A2 3. 2C19 4. 2C9

2

Which of the following best describes the normal behavior of children aged 3-6 years old playing with their genitalia during the phallic stage? 1. It is a sign of sexual deviance and should be discouraged. 2. It is a normal part of exploring their bodies and discovering their sexuality. 3. It indicates a fixation in the oral stage of development. 4. It suggests a potential psychological disorder that requires immediate intervention.

2

Which of the following physical exam finding would help the PMHNP differentiate anorexia nervosa from bulimia nervosa? 1. Russell sign 2. Low body max index 3. Erosion of dental enamel 4. Hypertrophy of salivary glands

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A 23-year-old woman is brought into the ER after attempting suicide by cutting her wrists. Which nursing action by the PMHNP would be of highest priority initially? 1. Assess her coping behaviors. 2. Assess her current level of suicidality. 3. Take her vital signs. 4. Assess her health history.

3

A 32-year-old female patient experiences motor restlessness, anxiety, irritability, weight loss, and short attention span. The patient's laboratory values indicate a thyroid-stimulating hormone level of 0.32 Mu/L. The psychiatric-mental health nurse practitioner suspects. 1. Attention-deficit hyperactivity disorder 2. Hypothyroidism 3. Hyperthyroidism 4. Major depressive disorder

3

A 72-year-old female is brought in by her husband with increasing forgetfulness, insomnia, decreased activity, and decreased appetite for 2 months. She has a history of hypertension and is being treated with lisinopril. The exam is normal, and the mini-mental status exam provides a score of 24 but she declines to answer some questions and needs to be urged to participate in the assessment. What is the most likely diagnosis? 1. Alzheimer disease 2. Vascular dementia 3. Depression 4. Delirium

3

A PMHNP and a staff nurse are discussing the amount of time required to perform safety rounds on a psychiatric inpatient unit. An initial evidence-based approach for investigating this topic is to: 1. Conduct a time study. 2. Identify community standards. 3. Perform a literature search. 4. Survey the nursing staff.

3

A PMHNP decides to exclude a patient from a new experimental pharmacological therapy because the PMHNP believes the patient cannot afford the medication. Which ethical principle is violated by the PMHNP? 1. Beneficence 2. Nonmaleficience 3. Justice 4. Veracity

3

A PMHNP is providing care to a patient with a history of substance abuse. The patient is interested in receiving medication-assisted treatment (MAT) for their addiction. What is the appropriate role of the PMHNP in this situation? 1. Refer the patient to a substance abuse counselor for MAT. 2. Inform the patient that as a PMHNP, they are not authorized to provide MAT. 3. Assess the patient's suitability for MAT and, if appropriate, initiate and manage the treatment. 4. Encourage the patient to seek MAT from a primary care physician.

3

A PMHNP is reviewing a recent incident where a patient experienced a significant adverse reaction to a newly prescribed medication. The PMHNP is prompted to reflect on the decision-making process that led to the medication choice. What is the purpose of the PMHNP's reflection on the decision-making process regarding the medication choice? 1. Blaming the PMHNP for the adverse reaction to the medication. 2. Ignoring the incident as isolated and unrelated to decision-making processes. 3. Identifying factors that contributed to the adverse reaction and learning from the experience. 4. Avoiding any further discussion about the incident to prevent discomfort.

3

A child who is seen by the psychiatric-mental health nurse practitioner has difficulty feeling safe with his caregiver and is unable to feel comfort. The work of which of the following theorists would help explain the child's behavior and guide actions: 1. Viktor Frankl 2. Freud 3. Bowlby 4. Jean Piaget

3

A new male patient has a 10-year history of substance abuse, depression, and anxiety. He is requesting Xanax. Which principle should the PMHNP employ moving forward? 1. Beneficence 2. Justice 3. Non-Maleficence 4. Veracity

3

A psychiatric mental health nurse practitioner (PMHNP) working in a pediatric clinic is assessing a 9-year-old boy, Liam, who has recently been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Liam's parents are concerned about his frequent motor and vocal tics. Which medication is the most appropriate to prescribe? 1. Methylphenidate (Ritalin) 2. Atomoxetine (Strattera) 3. Guanfacine (Intuniv) 4. Bupropion (Wellbutrin)

3

A psychiatric mental health nurse practitioner working in an outpatient clinic is evaluating Tom, a 45-year-old man, who has been prescribed oxycodone (OxyContin, 10 mg q12h) for chronic lower back pain for the past five years. Tom reports that he used to feel relief with one pill, but now he requires three pills to achieve the same level of pain relief. This is possibly an example of which process? 1. Kindling 2. Addiction 3. Tolerance 4. Potency

3

During an initial intake appointment with a PMHNP, a female patient reported insomnia, lack of interest in pleasurable activities, poor concentration, and loss of appetite after being diagnosed with human papillomavirus (HPV) 3 weeks ago. What mental health disorder should the PMHNP assess based on the patient's symptoms? 1. Conversion Disorder 2. Major depressive disorder 3. Adjustment disorder with depressed mood 4. Bipolar disorder

3

During patient education about sertraline (Zoloft), an adult psychiatric and mental health nurse practitioner focuses upon the potential side effect of: 1. Agranulocytosis. 2. Hypernatremia. 3. Sexual dysfunction. 4. Weight loss.

3

Established clinical guidelines suggest that suicidality is decreased by treating patients who have borderline personality disorder with: 1. eye movement desensitization and reprocessing. 2. cognitive-behavioral therapy. 3. dialectical behavioral therapy. 4. interpersonal therapy.

3

If given during pregnancy Sodium Valproate (Depakote) can cause which of the following medical problems in the baby? 1. Stevens-Johnson syndrome 2. Ebstein's anomaly 3. Spina bifida 4. Cleft palate

3

John, a 40-year-old man in recovery from substance use disorder, experiences a setback, and briefly returns to using substances. How might a PMHNP employing the recovery model respond? 1. "This setback is a failure in your recovery. Let's reassess your treatment plan." 2. "It's important to focus on abstinence, and any substance use is unacceptable." 3. "Let's explore what led to the setback, learn from it, and adjust your recovery plan accordingly." 4. "You should consider more intensive inpatient treatment to address your relapse."

3

Mary, a 45-year-old African American female, has been treated on Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical procedure. Which medication is strictly contraindicated with Isocarboxazid? 1. Morphine 2. NSAIDs 3. Methylphenidate 4. Acetaminophen

3

Mr. Smithers, an involuntarily hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered medication because he believes "Jesus Christ told him I am the prophet and must fast for a year." Your actions should be based on your knowledge of which of the following? 1. Psychiatric patients cannot refuse treatment. 2. Psychiatric patients do not always know what is good for them. 3. Psychiatric patients can refuse treatment. 4. Psychiatric patients cannot be trusted to make good healthcare decisions and, therefore, the nurse's best clinical judgment should guide action

3

Sarah, a twelve-year-old girl, frequently exhibits signs of anxiety and reluctance to take on new tasks or activities. She often refrains from starting new tasks, fearing potential disapproval or criticism, and is afraid of failure. According to Erik Erikson's psychosocial development theory, which stage is Sarah likely failing to master? 1. Trust versus Mistrust 2. Autonomy versus Shame and Doubt 3. Initiative versus Guilt 4. Identity versus Role Confusion

3

The PMHNP sees a 13-year-old boy who presents with distressing thoughts and tics. These symptoms developed 2 weeks after the patient developed a streptococcal infection. The patient presents with a fever, sore throat, and a headache. What is the most likely diagnosis? 1. Tourette's syndrome 2. Attention deficit hyperactivity disorder 3. Obsessive Compulsive disorder 4. Autism

3

The neurochemical pathophysiology of Tourette disorder involves: 1. Decreased levels of gamma-aminobutyric acid (GABA) and increased levels of glutamate in the brain. 2. Deficits in the prefrontal cortex-mediated executive functions of the brain. 3. Imbalances in dopaminergic, serotonergic, and noradrenergic systems in multiple regions of the brain. 4. Overstimulation of noradrenergic activity located in the locus coeruleus of the brain.

3

The neuroprotective treatment of choice for bipolar disorder is: 1. Carbamazepine (Tegretol) 2. Divalproex sodium (Depakote) 3. Lithium (Eskalith) 4. Risperidone (Risperdal)

3

The psychiatric nurse practitioner participates in a hospital-based quality improvement project. The nurse practitioner reviews four charts per month of a nurse practitioner colleague to ensure diabetes protocols are met. This process is a: 1. Core competency. 2. Force field analysis. 3. Peer review. 4. Risk analysis.

3

The psychiatric-mental health nurse practitioner is aware of the following signs to watch out for in patients taking clozapine (Clozaril): 1. Nosebleeds, bleeding gums, and skin rash 2. Mutism, muscle rigidity, and hyperthermia 3. Fever, sore throat, and chills 4. Ataxia, confusion, and hypothyroidism

3

The psychiatric-mental health nurse practitioner is concerned about access-to-care issues in the local community and wants to help develop health care policy to help patients access care more effectively. The nurse practitioner knows one of the most effective avenues for developing and advocating for policy is: 1. Asking the clinic manager to explore options for access. 2. Organizing a political protest. 3. Working with the local chapter of the nurse's professional association. 4. Writing letters to the editor of the local newspaper.

3

The psychiatric-mental health nurse practitioner is responsible for initiating quality improvement at a community mental health clinic. The effective strategy for evaluating the clinic's services is to: 1. a chart review analysis. 2. a root cause analysis. 3. a plan-do-study-act process. 4. failure effect mode analysis.

3

When working with a family in therapy, you plan to address differentiation of self, triangles, and genomes. What family therapy approval will you be utilizing? 1. Dialectical behavioral therapy 2. Strategic family therapy 3. Systemic family therapy 4. Structural family therapy

3

When working with an avoidant patient with a history of trauma, what type of communication techniques are helpful? 1. Techniques to decrease arousal 2. Clarification and close-ended questions 3. Techniques to increase arousal 4. Reflection and open-ended questions.

3

Which characteristic of Fluoxetine (Prozac) provides the greatest degree of safety for patients who have severe depression? 1. Greater efficacy than tricyclic antidepressants 2. Less potential for drug interaction 3. Less potential for injury with intentional overdose 4. Less potential for suicidal thinking

3

Which of the following structural changes is common in individuals with schizophrenia? 1. Increased Glutamate and Decreased GABA release 2. Increased Electrical activity in the frontal lobes 3. Increased size of the cerebral ventricles 4. Increased total brain volume

3

While providing a history, a patient requests that a PMHNP disclose the information gathered with no one but the patient's spouse. By respecting this request, the nurse practitioner demonstrates which component of a therapeutic relationship? 1. Nonmaleficence 2. Beneficence 3. Confidentiality 4. Veracity

3

A 25-year-old female presents with decreased appetite, memory loss, weight gain, and cold intolerance. To rule out organic causes, the psychiatric-mental health nurse practitioner should order a: 1. Comprehensive metabolic panel 2. Prolactin level 3. Cortisol level 4. Thyroid profile

4

A 5-year-old boy shows no interest in playing with other children and ignores adults other than his parents. He spends hours lining up his toy cars or spinning their wheels. He rarely uses speech to communicate, and his parents state that he has never done so. Physical examination indicates that his head is of normal circumference and his gait is normal. Which of the following is the most likely diagnosis for this boy? 1. Obsessive-compulsive disorder 2. Fragile X syndrome 3. Fetal alcohol syndrome (FAS) 4. Autism Spectrum Disorder

4

A PMHNP is evaluating a 10-year-old child, Sarah, referred for assessment due to frequent severe temper outbursts, irritability, anger, and mood dysregulation. Sarah's parents report that these episodes occur in various settings and are often disproportionate to the situation. Which of the following is the most likely diagnosis? 1. Post-Traumatic Stress Disorder (PTSD) 2. Major Depressive Disorder (MDD) 3. Conduct Disorder (CD) 4. Disruptive Mood Dysregulation Disorder (DMDD)

4

A PMHNP prescribes Fluoxetine to a patient recently diagnosed with major depressive disorder. The PMHNP understands that this aspect of care delivery is an example of which of the following ethical principles? 1. Veracity 2. Autonomy 3. Justice 4. Beneficence

4

A PMHNP working in a child and adolescent psychiatric unit meets regularly with the staff nurses of an adolescent inpatient psychiatric unit to improve the nurses' therapeutic interactions with the patients. Each nurse keeps a journal describing clinical interactions with an adolescent and examines the factors that hinder the nurse's ability to interact therapeutically with the patient. The PMHNP reviews the entries and provides written feedback. This teaching strategy is known as: 1. Concept mapping. 2. Discovery learning. 3. Problem-based learning. 4. Reflective practice.

4

A PMHNP working in an outpatient mental health clinic is conducting an assessment of a 40-year-old patient, Sarah, who presents with a long history of emotional detachment, a preference for solitary activities, and limited interest in close relationships, including with her own family. Sarah rarely experiences pleasure from activities and appears indifferent to both criticism and praise. Which of the following is the most likely diagnosis? 1. Major Depressive Disorder (MDD). 2. Schizotypal Personality Disorder (STPD). 3. Generalized Anxiety Disorder (GAD). 4. Schizoid Personality Disorder (SPD).

4

A patient with a diagnosis of schizophrenia has a history of suicidal ideation and suicide attempts. The PMHNP should consider which antipsychotic medication that is the only antipsychotic to reduce the risk of suicide in schizophrenia? 1. Abilify (Aripriprazole) 2. Latuda (Lurasidone) 3. Invega (Paliperidone) 4. Clozaril (Clozapine)

4

According to Erikson's Psychosocial Stages of Development, in what stage does the child need to learn important academic skills and compare favorably with peers in school to achieve competence? 1. Trust vs. Mistrust 2. Identity vs. Role Confusion 3. Initiative vs. Guilt 4. Industry vs. Inferiority

4

According to Erikson's stages of human development, the key event for people between the ages of 35 to 65 years (Generativity vs. Stagnation) is: 1. Independence 2. Love relationship 3. Reflection/acceptance of one's life 4. Parenting

4

According to current clinical guidelines for treating a patient with bipolar I disorder mania with psychotic features, an adult psychiatric and mental health nurse practitioner prescribes: 1. Lithium 2. Citalopram (Celexa) 3. Lamotrigine (Lamictal) 4. Quetiapine (Seroquel)

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An 18-year-old female diagnosed with a first episode of Schizophrenia is amenable to taking antipsychotic medication to lessen her hallucinations. She is opposed to taking meds that would cause her to gain weight. Which medication would be the most appropriate to prescribe? 1. Clozapine (Clozaril) 2. Olanzapine (Zyprexa) 3. Quetiapine (Seroquel) 4. Ziprasidone (Geodon)

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Before implementing evidence-based practice changes, an adult psychiatric and mental health nurse practitioner's initial action is to: 1. brainstorm with stakeholders and draft a detailed problem list. 2. compare data with internal and external benchmarks and coordinate ongoing education. 3. facilitate a collaborative multidisciplinary group to synthesize evidence and compare key themes. 4. identify potential barriers and facilitators that reflect patients' values and expectations.

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During a regular follow-up appointment with a PMHNP, a patient reports to the PMHNP that her husband who is currently at work just told her that he wants to commit suicide. The PMHNP's initial action is to: 1. Notify the husband's supervisor. 2. Notify the husband's family. 3. Ask the patient to check on her husband. 4. Contact the police and notify them of the husband's suicidal threat and location.

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During an outpatient psychiatric evaluation with a PMHNP, a depressed client reports persistent anger towards his former boss losing his job due to arguments and assaultive behavior towards coworkers. The client has been waiting outside the plant in the afternoon, watching for the boss to leave to confront him regarding terminated employment. What responsibility does the PMHNP hold in this situation? 1. Contact the client's boss to notify him of potential harm. 2. Ask the patient to sign a "no harm to others" agreement and document in the chart. 3. Advise the client to stop going to the plant and avoid any contact with the former boss. 4. Consult state board of nursing regarding state laws requirements on reporting potential harm.

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For 12 years, a 65-year-old patient with bipolar affective disorder has been treated with lithium (Eskalith) 900 mg daily. When oral hydrochlorothiazide (HCTZ) 12.5 mg daily is added for hypertension, the patient develops nausea, vomiting, ataxia, muscle weakness and the patient's serum lithium level is 2.0 mEq/L. The interaction of the Lithium and the Thiazide diuretic has induced: 1. Hypokalemia. 2. Hyponatremia. 3. Increased renal clearance of Lithium. 4. Reduced renal clearance of Lithium.

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For the past 18 months, an eight-year-old child has exhibited involuntary, purposeless, rapid recurrent movements of the arms and face as well as spontaneous unintelligible vocalizations. When receiving verbal cues, the child can decrease and sometimes extinguish the erratic movements for several minutes. The diagnosis is: 1. Obsessive-compulsive disorder 2. Chronic motor tic disorder. 3. ADHD 4. Tourette disorder

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If a patient from a specific culture is refusing to accept any diagnosis of mental health disorders because of shame, what could be done to address this barrier? 1. Educate the family 2. Political advocacy 3. Public health concern 4. Community education programs

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In counseling a 23-year-old married, Hispanic mother who brought her 4-year-old son to clinic for "mal de ojo" with symptoms of fitful sleep, diarrhea, vomiting, and fever, the PMHNP: 1. Identifies what steps the mother has already tried in caring for the child's symptoms 2. Explains that the symptoms are most likely caused by viral infection 3. Educates about importance of maintaining fluid and electrolyte imbalance 4. Respects the mother's understanding of the child's illness.

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Norepinephrine is a neurotransmitter that plays an essential role in the regulation of arousal, attention, and stress reaction. What area of the brain has a large majority of Norepinephrine neurons? 1. Raphe nuclei 2. Nucleus Accumbens 3. Nucleus of Meynert 4. Locus Coeruleus

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Sarah, a 14-year-old, is participating in a research study on cognitive development. During a problem-solving task, she demonstrates the ability to consider multiple perspectives and generate creative solutions. Which stage of Piaget's theory is Sarah most likely in? 1. Sensorimotor stage 2. Preoperational stage 3. Concrete operational stage 4. Formal operational stage

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The chief nursing officer of a large behavioral health system approached the PMHNP to discuss the new Healthcare Effectiveness Data and Information Set (HEDIS) behavioral health measures and specifications. The PMHNP is asked to do a retrospective chart review of all hospital discharge clients who received a follow-up visit within 7 days of discharge and within 30 days of discharge. The PMHNP has been asked to engage in which of the following? 1. Needs assessment project. 2. Plan, do, study, act project. 3. A task that is outside of the PMHNP's scope of practice. 4. Quality improvement initiative.

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What evidence-based treatment is used for a 12-year-old girl who was sexually abused by her stepfather: 1. Interpersonal therapy 2. Humanistic therapy 3. Existentially oriented therapy 4. Trauma-focused cognitive behavioral therapy

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What is an assumption of Humanistic therapy? 1. People can learn to identify, evaluate, and change their assumptions and core beliefs 2. Patients are doing the best they can, and they want to improve. 3. Individual is responsible for making meaning out of life. 4. People are naturally good, and people strive to achieve self-actualization and self-directed growth

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Which of the following medications has a unique mechanism that is both a serotonin and norepinephrine reuptake inhibitor? 1. Bupropion (Wellbutrin). 2. Sertraline (Zoloft) 3. Clomipramine (Anafranil) 4. Duloxetine (Cymbalta)

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Which set of laboratory results in a 45-year-old patient confirms hypothyroidism? 1. Increased thyroxine (T4) level and decreased thyroid-stimulating hormone levels. 2. Increased thyroxine (T4) level and increased thyroid-stimulating hormone levels. 3. Decreased triiodothyronine T3), thyroxine (T4), and thyroid-stimulating hormone levels. 4. Decreased thyroxine (T4) level and increased thyroid-stimulating hormone levels.

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