Practice Questions
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? A. Care provider B. Advocate C. Policy maker D. Stigma Reduction Agent
B: Advocate
A PMHNP notices that few substance abuse treatment programs apply evidence-based practice. The PMHNP wants to initiate such a treatment program to: A. implement the use of valid instruments B. improve outcomes through analysis and synthesis of evidence C. maximize interventions and increase skill utilization D. optimize revenue-generating potential
B: Improve outcomes through analysis and synthesis of evidence
Which of the following patient is at a higher risk of suicide?
A 68-year-old single Caucasian male with depression (this one has 5 risk factors)
John is a 58-year-old male patient with bipolar I disorder has been stable for 5 years on valproate and Seroquel. He was recently started on Fluticasone (Flonase) by his PCP. As the PMHNP treating John, you are concerned that the addition of the Fluticasone may cause:
A manic episode
Before implementing evidence-based practice changes, an adult PMHNP's initial action is to: A. Brainstorm with stakeholders and draft a detailed problem list B. Compare data with internal and external benchmarks and coordinate ongoing education C. Facilitate a collaborative multidisciplinary group to synthesize evidence and compare key themes. D. Identify potential barriers and facilitators that reflect patients' values and expectations.
D: Identify potential barriers and facilitators that reflect patients' values and expectations
Mary is a PMHNP who is working in a Hospitalist role. Mary has encountered over five incidences in which attending psychiatrists and medical residents have been demeaning to nursing staff and not answering calls in the middle of the night or telling the nursing staff to write orders and the MD would sign off in the a.m. Mary is concerned about errors and wants to improve quality, reduce errors to promote safety. What concept is Mary employing? A. Bullying B. Abuse C. Civil Disobedience D. Just Culture
D: Just Culture
A 12-year-old boy is brought to the PMHNP because his mother says the boys 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 made, 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?
Oppositional Defiant Disorder
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:
Parenting
What is an assumption of Humanistic therapy?
People are naturally good, and people strive to achieve self-actualization and self-directed growth
The study of what a drug does to the body is called:
Pharmacodynamics
A patient tells a PMHNP "I went to see my PCP and she told me my liver is working harder than it should and she thinks it might be due to drinking. I don't think I have a drinking problem, but I don't want to have any problems either. Can you give me the names of where Alcoholics Anonymous groups are located?" I told my PCP I will try and cut back a bit." What stage of recovery does this patient stand?
Preparation
A 48-year-old Caucasian male patient presents for his therapy session. He is sad about losing his wife recently to COVID-19. He reports feeling thoughts of hurting himself. He has a past history of overdosing on propranolol several years ago. Which of the following places him at higher risk for suicide?
Previous suicide attempt
A community has an unusually high incidence of depression and drug use among the teenage population. The public health nurses decide to address this problem, in part, by modifying the environment and strengthening the capacities of families to prevent the development of new cases of depression and drug use. What is this an example of?
Primary prevention
A mother brings in her 7 -year-old son for a psychiatric follow-up visit with the PMHNP. This is the 4th visit the PMHNP has had with the client, his mother, and his younger sister, Renee, now 7 months old. You notice that she has a decrease in head growth, along with stereotypic motions of the hands, often licking and slapping. Renee has also lost her language skills. What medical condition do you suspect Renee has developed?
Rett syndrome
What is the best treatment for AIDS dementia complex?
Antiretroviral therapy
A patient is diagnosed with schizophrenia. Which of the following would be the appropriate question for the PMHNP to ask when assessing side effects produced by dopamine antagonism in the nigrostriatal pathway?
Are you experiencing pill rolling tremors, shuffling gait, and masklike facial expression?
A married female patient has been in therapy with an adult psychiatric and mental health nurse practitioner for 3 months. The patient's husband abuses alcohol and refuses treatment. The night before the next scheduled appointment, the patient telephones the clinical nurse specialist stating that her husband is drunk, violent, and threatening to kill her. The PMHNP's priority intervention is to:
Arrange for the woman's safety
Which behavior reflects existentially oriented therapy?
Attempting to understand a patient's subjective world
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?
Autism
Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated with clozapine?
1A2
When studying pharmacodynamics involving receptors, you know that an agonist produces the following effect:
Activates a biological response and opens the ion channel
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: A. Conduct a literature search to determine whether data support the off-label use. B. Contact the pharmaceutical manufacturer to request related research findings. C. Prescribe the medication for off-label use. D. Report the colleagures to the state Board of Nursing
A: Conduct a literature search to determine whether data support the off-label use
During an initial intake appointment with a PMHNP, a female patient reported insomnia, lack of interest in pleasure 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?
Adjustment disorder with depressed mood
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? A. Meta-Analysis B. Cohort studies C. Opinions of expert committees D. Case control
A: Meta-Analysis
An 81-year-old female with a history of vascular dementia is brought to the hospital for increased agitation and urinary tract infection (UTI). Which of the following features most distinguishes the effects of delirium from dementia?
Altered level of consciousness
Which of these brain structures puts emotional meaning on a stimulus, forms emotional memories, and is involved with rage and fear?
Amygdala
Any court of law that evaluates the standards of care provided by the PMHNP: A. Compares actions to the standard of care provided by a psychiatrist. B. Considers what a reasonably prudent PMHNP would do in the same or similar circumstances. C. Evaluates patient satisfaction data. D. Reviews the nurse practitioner's charts for similar patients
B: Considers what a reasonably prudent PMHNP would do in the same or similar circumstance
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? A. Autonomy and veracity B. Decision capacity and comprehension. C. Confidentiality and beneficence D. Disclosure of information and voluntariness
B: Decision capacity and comprehension
A male patient informs an adult PMHNP that he has not slept in three days, has poor concentration, and denies fatigue. The patient presents with rapid speech, irritability, inflated self-esteem, and is uncooperative during assessment. What is the patient's most likely diagnosis:
Bipolar Disorder
Which of the following medication has a unique mechanism that is both a norepinephrine and dopamine reuptake inhibitor?
Bupropion (Wellbutrin)
While providing a history, a patient request that a PMHNP discloses 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? A. Nonmaleficence B. Beneficence C. Confidentiality D. Empathy
C: Confidentiality
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? A. Beneficence B. Nonmaleficence C. Justice D. Veracity
C: Justice
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? A. Beneficence B. Justice C. Non-Maleficence D. Veracity
C: Non-Maleficence
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?
Consult state board of nursing regarding state laws requirements on reporting potential harm.
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: A. Conduct a time study B. Identify community standards C. Perform a literature search D. Survey the nursing staff
C: Perform a literature search
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? A. Psychiatric patients cannot refuse treatment B. Psychiatric patients do not always know what is good for them C. Psychiatric patients can refuse treatment D. Psychiatric patients cannot be trusted to make good healthcare decisions and, therefore, the nurse's best clinical judgment should guide actions.
C: Psychiatric patients can refuse treatment
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:
Contact the police and notify them of the husband's suicidal threat and location
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 Mexico - 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?
Conversion disorder
A 32-year-old male with a history of chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, hypertension, and new-onset severe physiologic tremor presents to the clinic with his wife. The wife is worried that the patient is misusing alcohol beverages to self-treat his tremors. He has begun missing their children's school events and coming home late. He also has had more mood swings. Upon questioning the patient, he admits to increasing his overall alcohol intake. However, he does not acknowledge that he has a problem with alcohol and is in control. Vital signs are stable, and medications are appropriately reconciled and refilled. Which of the following is a questionnaire criterion available for use and at what stage of recovery does this patient stand?
CAGE and he is in pre-contemplation
Which mood stabilizer is associated with potential life-threatening rash in the Asian population?
Carbamazepine (Tegretol)
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?
Clozaril (clozapine)
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?
Cognitive Therapy
During a follow-up assessment, a PMHNP asks the patient to count backwards from 100 by sevens. What aspect of mental status exam is being assessed?
Concentration
A middle-school boy repeatedly lies, steals, bullies' peers, instigates fights, and inflicts harm without feeling any regret or remorse. These are characteristics of:
Conduct disorder
A patient is being treated for psychosis two weeks ago presents with hyperthermia, muscle rigidity, mutism, leukocytosis, and myoglobinuria. These symptoms are identified by the PMHNP as?
Neuroleptic malignant syndrome and administers dantrolene
The PMHNP sees a 13-year-old boy who presents with distressing thoguths 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?
Obsessive Compulsive Disorder
While working with an older male client, the nurse begins to think that the client reminds her of her grandfather and responds as if she was the granddaughter. The nurse is developing which of the following?
Countertransference
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? A: Veracity B: Autonomy C: Justice D: Beneficence
D: Beneficence
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? A. Educate the family B. Political Advocacy C. Public health concerns D. Community education programs
D: Community education programs *not family education
The PMHNP is asked to consult with a local inpatient psychiatric facility to provide nursing staff development. After meeting with the administrator to identify the nature of the problem requiring the consultation, the PMHNP's next step is to: A. Create an interdisciplinary teaching team B. Develop outcome measures C. Market the educational plan D. Utilize a survey to assess the educational needs of the staff
D: Utilize a survey to assess the educational needs of the staff
What muscle relaxant is recommended to be used in the treatment of neuroleptic malignant syndrome (NMS)?
Dantrolene
When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons?
Decreased protein binding
Which set of laboratory results in a 45-year-old patient confirms hypothyroidism?
Decreased thyroxine (T4) level and increased thyroid-stimulating hormone levels
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?
Depression
During a structural therapy session, the PMHNP requests that the family improvise a play about their interrelationships. The nurse practitioner uses this method as a complement of structural therapy to:
Develop rigid boundaries and hierarchies
Established clinical guidelines suggest that suicidality is decreased by treating patients who have borderline personality disorder with:
Dialectical behavioral therapy
The PMHNP sees a 12-year-old patient who takes Lisdexamfetamine (Vyvanse) 50mg daily for ADHD. The NP opbserves a tic, which the parents report began after the patient started taking the psychostimulant, and it has been increasing in severity. Both the parents and the school report that the medication is helpful. The PMHNP:
Discontinues the psychostimulant, prescribes guanfacine extended release (Intuniv), and monitors the patient
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:
Early childhood
The PMHNP is aware of the following signs to watch out for in patients taking clozapine (Clozaril):
Fever, sore throat, and chills
Working with a 48-year-old patient recently diagnosed with schizophrenia and working using a recovery model:
Focus on his feelings, interests, and dreams
A client who is experiencing difficulties with working memory, planning, and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his or her knowledge that these symptoms represent problems with the:
Frontal lobe
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?
Generativity vs. Stagnation
A 69-year-old man with a diagnosis of delirium has symptoms of psychosis which include frightening auditory and visual hallucinations and paranoid delusions. Which of the following medications should be chosen first for this man's symptoms?
Haloperidol
A patient with borderline personality disorder experiences intense anxiety when an adult PMHNP goes on vacation. The best explanation for this reaction is that the patient:
Has failed to master object constancy
The anatomical structure of the limbic system that is associated with a reaction to stress is the:
Hippocampus
A 32-year-old female patient experiences motor restlessness, anxiety, irritability, weight loss, and short attention span. The patient's lab values indicate a thyroid-stimulating hormone level of .32 Mu/L. The PMHNP suspects:
Hyperthyroidism
Which of the following physical exam findings would help the PMHNP differentiate anorexia nervosa from bulimia nervosa?
Low body mass index
Appraisal of patient's suicidal ideation, plan, method, intent, and access to implement plan would be documented in which part of standard psychiatric evaluation?
Mental status exam
Mary a 45-year-old African American female who 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?
Methylphenidate
The neurochemical pathophysiology of Tourette disorder involves:
Imbalances in dopaminergic, serotonergic, and noradrenergic systems in multiple regions in the brain
Which of the following structural changes is common in individuals with schizophrenia?
Increased size of the cerebral ventricles
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?
Industry vs. Inferiority
Using the Patient Health Questionnaire (PHQ-9), a patient receives a score of 25. What is the next action of the PMHNP?
Initiate an antidepressant and/or therapy
Which characteristic of fluoxetine (Prozac) provides the greatest degree of safety for patients who have severe depression?
Less potential for injury with intentional overdose
Sarah presents for her initial intake appointment with complaints of depression. She is being treated for hypertension and asthma by her primary care provider. Knowing that certain medications can cause or exacerbate depression; you obtain a complete medication history. Which of the following medications is known to exacerbate or cause depression?
Propranolol
A 45-year-old African American male diagnosed with schizophrenia. Arrives at your clinic for a regular medication appointment. He is currently stabilized on chlorpromazine. You notice his face appears mask-like, and he walks with a shuffling gait. Based on this information, what extrapyramidal symptoms side effect would you suspect?
Pseudo-Parkinsonism
A patient has been treated for the past several years with fluphenazine (Prolixin). You notice that he is drooling and has a tremor and slight piull-rolling movement of the fingers. These are the extrapyramidal symptoms known as:
Pseudo-Parkinsonism
According to current clinical guidelines for treating a patient with bipolar I disorder mania with psychotic features, an adult PMHNP prescribes:
Quetiapine (Seroquel)
Serotonin is a neurotransmitter that is implicated in sleep and mood. What area of the brain has a large majority of serotonin neurons?
Raphe nuclei
For 12 years, a 65-year-old patient with bipolar disorder has been treated with lithium (Eskalith) 900mg daily. When oral HCTZ 12.5mg daily is added for hypertension, the patient develops nausea, vomiting, ataxia, and 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:
Reduced renal clearance of lithium
When working with a 26-year-old, Mike, who presents for treatment of cannabis use and gambling, you use motivational interviewing techniques. As a PMHNP, you are familiar with the core counseling skills used in motivational interviewing. Mike makes the following statement: "I don't know why I came here in the first place, but I thought maybe some medication would help me." You respond by saying, "You're feeling confused about the process," and Mike replies, " I never thought I'd need to come to a place like this." You respond, "You kept your appointment today and I appreciate the courage it took for you to come here." What two motivational interviewing techniques are used in this interaction?
Reflecting and affirming
A 24-year-old female attempts suicide by overdose with the MAOI phenelzine. She is stabilized at the hospital. Ten days later she is started on venlafaxine and becomes tachycardic and diaphoretic, and she develops myoclonic jerks. What condition is this?
Serotonin syndrome
A week after raising the dose of clomipramine a patient treated for depression presents to the clinic with reports of acute change in mental status, fever, and hyperreflexia. As the treating PMHNP, you know these symptoms are consistent with which of the following?
Serotonin syndrome
During patient education about sertraline (Zoloft), an adult psychiatric and mental health nurse practitioner focuses upon the potential side effect of:
Sexual dysfunction
A patient with a known diagnosis of bipolar I disorder presents to your clinic complaining of manic symptoms and insomnia. Your patient has been stable on lithium for the past six months. To determine if a medication change or increase is warranted, it is important to gather more information. You suspect a possible medication-induced manic episode when the patient endorses what?
She recently had an acute flare-up of her rheumatoid arthritis and received treatment for one week of stabilization of symptoms.
Dialectical behavioral therapy (DBT) draws on cognitive theory and behavioral theory, along with other theories. Elements of behavioral therapy in DBT include which of the following?
Skills training and relaxation
If given during pregnancy sodium valproate (Depakote) can cause which of the following medical problems in the baby?
Spina bifida
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:
Strategic therapy
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?
Systemic family therapy
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?
Take her vital signs
When working with an avoidant patient with a history of trauma, what type of communication techniques are helpful?
Techniques to increase arousal
A client says to the PMHNP, "Some days life is just not worth it. All my wife and I ever do is fight and scream. Things at home would be calmer and simpler if I just wasn't there anymore." The most therapeutic response for the PMHNP to make it:
Tell me what you mean by "it would be simpler if you just weren't there anymore."
A new prescription of carbamazepine (Tegretol) is given to a patient whose baseline WBC count is 5,000/uL and ANC is 4,000/uL. Laboratory tests show that the patient's WBC count has decreased to 2,500/uL and ANC has decreased to 750/uL after two weeks of therapy. Similar outcomes are obtained when the lab studies are repeated. The patient does not present with any signs of infection. What is the next action of the PMHNP?
Tells the patient to stop taking Tegretol and recheck the ANC and WBC
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 PMHNP identifies these symptoms as signs of lithium toxicity. What is the priority action of the PMHNP?
Tells the patient to stop taking lithium and orders a serum lithium level
A patient who was diagnosed with major depressive disorder comes to the clinic for a refill of sertraline (Zoloft). The PMHNP explains that the medication is prescribed for:
Tertiary prevention
A 64-year-old Caucasian male referred for treatment of refractory depression by his PCP reports continued lack of purpose, insomnia, decreased energy, reduced interest in pleasurable activities since losing his wife hit by a drunk driver 3 months ago. Which of the following is an assessment priority?
Thoughts of self-harm, plan, intent, access
Your client Sam is being treated for panic disorder with agoraphobia. He currently is being prescribed paroxetine (Paxil CR, 37.5 mg q.d.) and clonazepam (Klonopin, 0.5mg q.d., prn). He has been on clonazepam for 2 years and admits to needing 4 pills to achieve the same effect that 1 pill initially produced. This is possibly an example of which process?
Tolerance
For the past 18 months, an 8-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:
Tourette disorder
An 18-year-old female diagnosed with a first episode of schizophrenia is amenable to take 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?
Ziprasidone (Geodon)
The neuroprotective treatment of choice for bipolar disorder is:
lithium (Eskalith)
