Clinical PMHNP Exam 1 study questions

Select the classic symptoms of PTSD: (check all that apply) A. Intrusive symptoms B. Avoiding stimuli associated with the trauma C. Increased autonomic arousal D. Psychomotor retardation

A. Intrusive symptoms B. Avoiding stimuli associated with the trauma C. Increased autonomic arousal

The following medications have FDA approval to treat panic disorder and agoraphobia. Which of the following would you use with caution in an elderly patient or a patient with cardiovascular disease? (check all that apply A. Citalopram B. Fluoxetine C. Paroxetine D. Venlafaxine

A. Citalopram D. Venlafaxine

When de-escalating a patient what is the recommended closest distance that you should stand from the patient? A. 1 arm length B. 2 arms length C. six feet D. 10 feet

2 arms length

Select the true statement regarding anxiety disorders: (select all that apply) A. GAD co-occurs with other anxiety disorders B. Differentials for anxiety disorders are CAD and pulmonary disorders C. Anxiety disorders should be treated at any severity due to anticipated progression in severity over time D. Hypothyroidism is a differential for anxiety

A. GAD co-occurs with other anxiety disorders B. Differentials for anxiety disorders are CAD and pulmonary disorders

Select the key components of de-escalation: A. Hands should be visible and not clenched B. Directly face the patient but stand at arm's length C. Fold your arms D. Provide an in-depth explanation of the problem as you see it E. If the patient is delusional point out that this is faulty thinking F. Introduce yourself and ask the patient his/her name and how they would like to be addressed G. Have your back to the exit so the patient must go around you to leave the room. H. Use clarifying sentences

A. Hands should be visible and not clenched F. Introduce yourself and ask the patient his/her name and how they would like to be addressed H. Use clarifying sentences

Which of the following health conditions have a high co-morbidity with depression? A. Hypertension B. Asthma C. Diabetes mellitus D. Cardiovascular disease E. Celiac disease F. Cognitive impairment G. Obesity H. Cancer

A. Hypertension C. Diabetes Mellitus D. Cardiovascular disease F. Cognitive impairment G. Obesity H. Cancer

Your patient is extremely agitated and it is evident that the patient needs medication to calm him down. Which of the following would be the least effective way to approach to this subject? A. "When you were this worked up before we gave you a shot and it really helped so I have ordered the same medicine for you" B. "I need to protect you from hurting someone so I would like for you to take some medication to help you stay in control." C. "I am going to need to give you some medication to help you maintain control. Would you prefer something by mouth or by a shot?" D. "In order to protect yourself from injury I am going to need to give you some medication. What has worked for you in the past or do you have a preference? "

A. "When you were this worked up before we gave you a shot and it really helped so I have ordered the same medicine for you"

For every case of reported elder abuse how many cases are unreported? A. 5 B. 10 C. 15 D. 20

A. 5

What are the characteristics of abusers of the elderly? A. Adult children B. Low SES C. Dependent on the elderly person D. Suffering from external stressors E. Black F. Extremely solicitous and refuses to leave the side of the victim during office visits

A. Adult children B. Low SES C. Dependent on the elderly person D. Suffering from external stressors F. Extremely solicitous and refuses to leave the side of the victim during office visits

Anxiety disorders A. Are greater among people at lower socioeconomic levels B. Are highest among those with higher levels of education C. Are lowest among homemakers D. Have shown different prevalence with regard to social class but not ethnicity

A. Are greater among people at lower socioeconomic levels

Select the gold standard nonpharmacological treatment for social anxiety disorder: A. CBT B. IPT C. Exposure and Response Therapy D. Acceptance and Commitment Therapy

A. CBT

Select the major causes of delirium according to Sadock & Sadock. (Select all that apply) A. CNS disease B. Systemic disease C. Pharmacologic agents D. Insomnia

A. CNS disease B. Systemic disease C. Pharmacologic agents

Social anxiety disorder (SAD) is one of the most common anxiety disorders. Select the true statements related to SAD. (select all that apply) A. More common in women with onset in adolescence B. Chronic and unremitting C. Low SES, single and low educational achievement are risk factors D. High comorbidity with MDD

A. More common in women with onset in adolescence B. Chronic and unremitting C. Low SES, single and low educational achievement are risk factors D. High comorbidity with MDD

You are seeing a 75-year-old patient who has been brought to an emergency room for agitation and reported hallucinations. His spouse states that he had been going about his usual routine when he began saying things that did not make sense, he was unsure where he was and thought that she was her sister. When she tried to get him into the car to take to the ED, he was argumentative and threatened to jump out of the car which was completely opposite of his usual behavior. You try in to interview the patient but he is unable to provide you with any meaningful information. He is threatening to leave the ED and had to be held down for a blood draw. What is your next step? A. Order a CBC with diff, CMP, UA, urine toxicology B. Consult with the ED provider for obtaining an LP and EEG with possible neuroimaging C. Order risperidone orally disintegrating tablet and assess for efficacy D. Correct the cause of the delirium rather than giving any psychotropics

A. Order a CBC with diff, CMP, UA, urine toxicology B. Consult with the ED provider for obtaining an LP and EEG with possible neuroimaging C. Order risperidone orally disintegrating tablet and assess for efficacy

All of the following are true about panic disorder except A. Patients become concerned after the first one or two panic attacks B. Excessive caffeine intake can exacerbate symptoms C. Comorbid depression increases risk for committing suicide The overall course is variable

A. Patients become concerned after the first one or two panic attacks

In the Natural Medicines database when looking for complementary treatments for anxiety which of the following was found to be "possibly ineffective"? A. Probiotics B. Gingko C. Lavender D. Melatonin

A. Probiotics

Select the characteristics that suggest a good prognosis for a patient with PTSD (select all that apply) A. Rapid onset of the symptoms B. Duration of symptoms less than 6 months C. Strong social supports D. Co-morbid physical health condition

A. Rapid onset of the symptoms B. Duration of symptoms less than 6 months C. Strong social supports

Which of the following statements are correct related to suicidality in the elderly? A. Suicides increase with age and therefore are the highest risk for suicide B. Attempts at suicide are more serious C. More lethal than the younger population D. Depression is easier to treat with lower relapse rates

A. Suicides increase with age and therefore are the highest risk for suicide B. Attempts at suicide are more serious C. More lethal than the younger population

In the Cutler video on depression, he highlights that there are 200 different ways to meet the diagnostic criteria for depression. A. True B. False

A. True

Select the best treatment options for patients with delirium and Parkinson's disease. (Select all that apply). A. Try decreasing anti-Parkinson's drugs B. Order clozapine first line C. Order quetiapine first line D. Stop all medications in the event that meds are causing the delirium

A. Try decreasing anti-Parkinson's drugs B. Order clozapine first line

Isolated panic attacks without functional disturbances A. Usually involves anticipatory anxiety or are phobic B. Are part of the criteria for diagnostic panic disorder C. Occur in less than 2% of the population D. Rarely involve avoidance E. None of the above

A. Usually involves anticipatory anxiety or are phobic

According to the Thase presentation on the top 10 drug combinations for MDD what should be considered when a Level I strategy is ineffective? A. Was the patient taking the medication as prescribed? B. Is there an occult medical illness? C. Could the patient be using a substance that was not reported during visits? D. Do I have the correct diagnosis? E. Could the patient be malingering?

A. Was the patient taking the medication as prescribed? B. Is there an occult medical illness? C. Could the patient be using a substance that was not reported during visits? D. Do I have the correct diagnosis?

A patient with schizophrenia is pregnant. What should her healthcare provider know about the factors associated with schizophrenia that impact the patient's health during pregnancy? A. Antipsychotics are more closely associated with fetal malformations and neonatal behavioral effects than mood stabilizers and benzodiazepines B. High rates of smoking, SUD, obesity and low SES are related to poor prenatal care and outcomes C. Periods of high risk for fetus include third trimester of pregnancy and time of delivery D. Pregnancy involves increased symptoms for women with schizophrenia

B. High rates of smoking, SUD, obesity and low SES are related to poor prenatal care and outcomes

When diagnosing a patient with PTSD there are specifiers of dissociative symptoms, either depersonalization or derealization. When is the specifier "with delayed expression" appropriate? A. If full diagnostic criteria are not met until at least 4 months after the event B. If full diagnostic criteria are not met until at least 6 months after the event C. If full diagnostic criteria are not met until at least 8 months after the event D. If full diagnostic criteria are not met until at least 12 months after the event

B. If full diagnostic criteria are not met until at least 6 months after the event

Which theory of depression was developed based on observing that patients who were being treated for Hep C developed depressive symptoms? A. The monoamine theory B. The inflammation theory C. The HPA axis theory D. The stress-diathesis theory

b. The inflammation theory

To minimize the risk of agranulocytosis a patient's baseline ANC needs to exceed a certain level to initiative treatment with clozapine. What is this minimum baseline ANC level? A. 1000 B. 1500 C. 2000 D. 2500

B. 1500

In the Star D trial for patients that achieved remission what percentage relapsed after 4.4 months? A. 25% B. 33% C. 42% D. 53%

B. 33%

For patients that respond to treatment with pharmacotherapy but are at high risk for recurrent depressive episodes, howe long should maintenance pharmacotherapy be continued? A. At least 6 months B. At least 12 months C. At least 24 months Indefinitely

B. At least 12 months

The DSM-5 identifies a key difference between the diagnoses of schizophreniform disorders and schizophrenia. What is the key difference? A. Presence of absence of major mood symptoms concurrent with positive symptoms B. Duration of symptoms C. Presence or absence of hallucinations D. Presence or absence of concurrent drug use

B. Duration of symptoms

Having a patient sign a "no suicide contract" has demonstrated efficacy in reducing suicides among those who sign these "contracts". A. True B. False

B. False

In assessment of the patient with a TBI an PTSD once must first identify the biochemical alterations versus the psychological alterations. A. True B. False

B. False

Rates of remission increased with each additional change in therapy, especially when switching. A. True B. False

B. False

When should adjunctive therapy be considered in treating MDD? (select all that apply) A. Already tried 3 or > antidepressants B. Initial antidepressant well tolerated C. Partial response (>50% improvement) D. Specific residual symptoms or side effects that can be targeted E. Severity of depression, more functional impairment F. Patient preference

B. Initial antidepressant well tolerated D. Specific residual symptoms or side effects that can be targeted E. Severity of depression, more functional impairment F. Patient preference

Which of the following benzodiazepines is recommended when it is determined that a benzodiazepine is necessary in the elderly? A. Alprazolam B. Lorazepam C. Diazepam D. Clonazepam

B. Lorazepam

Dissociative fugue A. Is caused by heavy alcohol use B. Occurs more often during wartime and natural disasters C. Has new identities that are more complete than the dissociative identity D. Identities can alternate as in dissociative identity disorder

B. Occurs more often during wartime and natural disasters

The core features of dementia with Lewy bodies include A. Disturbance of consciousness B. Recurrent detailed visual hallucinations C. Cognitive decline caused by cerebrovascular disease D. Progressive language dysfunction Gradual changes in personality

B. Recurrent detailed visual hallucinations

In the treatment of aggression and agitation in the elderly, the algorithm suggests which medication below is first line as a daily med and which medication is suggested first line for prn use? A. Quetiapine/trazodone B. Risperidone/trazodone C. Aripiprazole/lorazepam D. Risperidone/lorazepam

B. Risperidone/trazodone

Your patient was started on fluoxetine and after ten weeks of treatment his PhQ 9 score is 9. What is your assessment of the efficacy of treatment based on this score? A. The patient is in remission B. The response is adequate but not in remission C. The response is possibly inadequate D. The response is inadequate

B. The response is adequate but not in remission

In order to assess agitation in a patient the practitioner should: A. Use past experiences with patients to compare to this patient B. Use an objective scale such as the Behavioral Activity Rating Scales C. Find the most experienced person with assessing agitation D. Avoid jumping to conclusions and monitor the patient over time

B. Use an objective scale such as the Behavioral Activity Rating Scales

A health care provider suspects a patient has schizophrenia and orders an MRI or CT. What is the value of ordering these tests? A. No value, as these tests rarely lead to diagnosis of a clinically relevant disorder B. High value as psychosis is caused by diverse symptoms and patients want to rule out everything before being diagnosed as schizophrenic C. While controversial, a normal MRI or CT can exclude some treatable causes of psychosis and support diagnosis of schizophrenia D. Little value, as you expect a normal test

C. While controversial, a normal MRI or CT can exclude some treatable causes of psychosis and support diagnosis of schizophrenia

In order to establish a diagnosis of adjustment disorder related to a stressful event when must symptoms develop? A. Within one month B. Within two months C. Within 3 months D. Within 6 months

C. Within 3 months

Which of the following second generation antipsychotics are equivalent as one is metabolized into the other drug? A. olanzapine to risperidone B. aripiprazole to olanzapine C. risperidone to paliperidone D. paliperidone to aripiprazole

C. risperidone to paliperidone

In the Star*D trial what percentage of patients treated for depression failed to respond to initial pharmacotherapy? A. 20% B. 30% C. 40% D. 50%

D. 50%

Your patient has experienced her first episode of MDD and is in remission. How long should the antidepressant be continued after remission has been achieved to reduce the risk of relapse? A. 2 months B. 4 months C. 6 months D. One year

C. 6 months

Even while on maintenance doses of their APS, some percentage of schizophrenic patients will relapse each year. What is this percentage? A. <60% B. <50% C. <40% D. <30%

C. <40%

Select the major neurotransmitter implicated in delirium: A. Dopamine B. Serotonin C. Acetylcholine D. Glutamate

C. Acetylcholine

A 28-year-old male with a 5-year history of schizophrenia is brought to the ER unconscious by his parents. He is taking trifluoperazine. Exam reveals B/P 175/100, temp of 102 degrees, sweating, confusion, disorientation and increased muscle tone. Lab results indicate a high WBC and impaired renal function. What is the best initial intervention in this case? A. Haloperidol B. Propranolol C. Bromocriptine D. Lorazepam

C. Bromocriptine

You have diagnosed a 53-year-old male with moderate MDD and he has declined psychotherapy but has agreed to pharmacotherapy. He has diagnoses of Type 2 D.M. with a BMI of 32.1. Which of the following antidepressants would provide a dual benefit for this patient? A. Sertraline B. Fluoxetine C. Duloxetine D. Mirtazapine

C. Duloxetine

Depersonalization disorder is characterized by A. Gradual onset B. Onset impaired reality testing C. Ego-dystonic symptoms D. A brief course and a good prognosis E. Occurrence in the late decades of life

C. Ego-dystonic symptoms

Your patient recently lost his wife of 50 years and he has been tearful and feeling lost without her. After a thorough history that did not suggest the patient suffered from a depressive disorder previously you diagnose him with adjustment disorder with depressed mood. Which is the best treatment option? A. Sertraline B. Fluoxetine C. Group therapy with others who have lost a spouse D. Dialectical behavior therapy

C. Group therapy with others who have lost a spouse

You walk into the room of a patient in an acute care facility where you have been asked to consult with due to the patient's bizarre behavior. The patient is a 6'5" former body builder who is pacing the room, talking loudly and hurling verbal threats about wanting to hurt someone. You are fearful as the last time you encountered a patient such as this you were assaulted and ended up needing several stitches. Your decision would be to: A. Talk in a calm, reassuring manner to the patient B. Make eye contact so that the patient knows you are watching him C. Leave the room to secure someone else to work with the patient D. Leave the room to secure someone else to work with the patient

C. Leave the room to secure someone else to work with the patient

Delusional disorder has numerous subtypes. Which is the most common? A. Grandiose type B. Jealous type C. Persecutory type D. Erotomanic type

C. Persecutory type

Echolalia is likely to be a prominent part of the clinical picture in a certain disorder. Which of the following is it? A. Tic disorders B. Selective mutism C. Schizophrenia with catatonia D. Depression

C. Schizophrenia with catatonia

Your patient is a 41-year-old female without any history of chronic illnesses. She is seeing you in your office after reporting she has been to the emergency room three times in the past month for what she thought was a heart attack. After the third episode she was told that her symptoms are related to a panic attack and she should see a PMHNP. After conducting a thorough history and an MSE along with reviewing screening questionnaires you diagnose her with generalized anxiety disorder (F41.1) and panic disorder (F41.0). Which of the following options would be the best treatment plan for this initial visit? A. CBT B. Sertraline 50 mg p.o. Q.D. (#30, 1 refill) C. Sertraline 50 mg p.o. Q.D. (#30, 0 RF) CBT and alprazolam 0.5 mg p.o. up to t.i.d. prn anxiety (#15) D. Sertraline 50 mg p.o. Q.D. (#30, 0 RF & CBT)

C. Sertraline 50 mg p.o. Q.D. (#30, 0 RF) CBT and alprazolam 0.5 mg p.o. up to t.i.d. prn anxiety (#15)

Certain indicators are predictors of good treatment response in patients with first episode psychosis. Which is one of those indicators? A. Male gender B. High level of expressed emotion in the patient's family C. Shorter duration of untreated psychosis D. Severe hallucinations/delusions

C. Shorter duration of untreated psychosis

Which of the following epidemiological statements is true regarding anxiety disorders? A. Panic disorder has the lowest heritability B. The mean age of onset is higher in girls C. The age of onset is earlier than that of mood disorders D. Rates in males peak the fourth and fifth decades of life E. All of the above

C. The age of onset is earlier than that of mood disorders

Anxiety can be deconstructed into two core symptoms; fear and worry. Where is fear regulated? A. The CSTC loop B. The prefrontal cortex C. The amygdala D. The hippocampus

C. The amygdala

In the patient described above you have assessed his capacity. Select the components for assessing capacity. A. Ability to communicate a choice B. Ability to understand relevant information C. Ability to appreciate risks and benefits D. Ability to rationally manipulate the information at hand A. A, C B. B, D C. C D. A, B, C, D

D. A, B, C, D

You have diagnosed your patient with Major Depressive Disorder and after six weeks of being treated with fluoxetine 20 mg there is no treatment response. According to the VA/DoD Guidelines for treatment of MDD what is the next step? A. Switch to another monotherapy either an antidepressant or psychotherapy. B. Switch to a different antidepressant C. Augment with a second antidepressant D. Augment with a second medication or psychotherapy A. A, C B. B C. C D. A, D

D. A,D

Culture and race may affect schizophrenia outcomes and how practitioners would treat a particular patient. Which of the following statements regarding the interaction between culture, race and schizophrenia is true? A. African Americans are more likely to be diagnosed with mood disorders than schizophrenia compared to other races B. Race-based bias in diagnosis and treatment is not related to interpretations or clinical judgments by clinicians C. Lack of cultural competence does not influence care disparity D. African Americans with schizophrenia are less likely to be diagnosed with comorbid affective or anxiety disorders

D. African Americans with schizophrenia are less likely to be diagnosed with comorbid affective or anxiety disorders

The risk of developing anxiety disorders is enhanced by: A. Depression B. Substance abuse C. Eating disorders D. All of the above

D. All of the above

When assessing a patient for bipolar disorder who is not manic (which is very easy to identify), it is important to consider differentials. What are differentials to consider for bipolar disorder? A. Substance use B. Medication withdrawal C. Medication side effects D. Hyperarousal state with PTSD E. A panic attack A. A, B, C B. D, E C. A, C D. All of the above

D. All of the above

Symptoms of PTSD can be difficult to distinguish from panic disorder and generalized anxiety disorder because all feature high anxiety and autonomic arousal. What is the key to correctly diagnosing PTSD? A. Asking about nightmares B. Ascertaining the persistence of the anxiety C. Asking about symptoms of tachycardia and hyperventilation D. Associating the symptom onset to a traumatic event

D. Associating the symptom onset to a traumatic event

Patients with schizophrenia have been found to have similar characteristics related to brain structure. What is this characteristic? A. Enlarged thalamus B. Decreased ventricular volume C. Increased frontal lobe activity D. Brain volume deficit

D. Brain volume deficit

Select the most prevalent psychiatric disorder observed with patients with TBI A. Generalized anxiety disorder B. PTSD C. Agoraphobia D. Depression

D. Depression

Generalized anxiety disorder A. Is least likely to coexist with another mental disorder B. Has a female to male ratio of 1:2 C. Is a mild condition D. Has about a 50% chance of recurrence after recovery E. Has a low prevalence in primary care settings

D. Has about a 50% chance of recurrence after recovery

Poor insight is common in schizophrenia. Approximately 50% of all patients exhibit severe, pervasive and persistent problems with insight. Which of the following statements correctly describes the role of insight and depression in schizophrenia? A. Partial insight is common but depression is relatively rare B. Impaired insight is a hallmark feature of schizophrenia; patients become depressed when their level of insight deteriorates C. Depression with predominantly low mood is quite common, but impaired insight is relatively rare D. Impaired insight is a hallmark of schizophrenia; patients become depressed after improvement in insight

D. Impaired insight is a hallmark of schizophrenia; patients become depressed after improvement in insight

Select the factor below that does NOT play a role in the development of PTSD A. Presence of ACEs B. Inadequate peer or family support\ C. Genetic vulnerability D. Male gender E. Recent excessive alcohol intake

D. Male gender

A 32-year-old male presents claiming that his father is trying to kill him by poisoning his food. The patient reports poor sleep for the past 5 weeks as well as auditory hallucinations. He has become increasingly withdrawn and suspicious over the past 2 months and is talking to himself. What is the appropriate diagnosis? A. Schizoaffective disorder B. Delusional disorder C. Brief psychotic disorder D. Schizophreniform disorder

D. Schizophreniform disorder

Several; medical conditions can cause psychosis. Which of the following medical disorders can cause psychosis? A. Rheumatoid arthritis B. Asthma exacerbation C. Heart disease D. Systemic lupus erythematosus

D. Systemic lupus erythematosus

Organic amnesias are distinguished from dissociative amnesias by which of the following? A. They do not normally involve recurrent identity alteration B. The amnesia is not selectively limited to personal information C. The memories do not focus on an emotionally traumatic event D. The amnesia is more often anterograde than retrograde E. All of the above

E. All of the above

Which of the following statements regarding anxiety and gender differences is true? A. Women have greater rates of almost all anxiety disorders B. Gender ratios are nearly equal with OCD C. No significant difference exists in average age of anxiety onset D. Women have a twofold greater lifetime rate of agoraphobia than men E. All of the above

E. All of the above

Which of the following classes of drugs has not demonstrated a benefit in the treatment of PTSD? (Check all that apply) A. SSRIs B. Tricyclics C. MAOIs D. antiepileptic drugs (AEDs) E. Antipsychotics F. Anti-adrenergic agents

E. Antipsychotics

Clinical symptoms associated with HIV encephalopathy diagnosis include all of the following EXCEPT: A. Psychomotor slowing B. Problems with memory and concentration C. Mood and personality changes D. Hyperreflexia and paraparesis E. Early-onset aphasia

E. Early-onset aphasia