Purple Book Question Review

B. Gustatory hallucinations

Which types of hallucination is rare in persons with psychotic illnesses is often associated with an organic etiology? A. Auditory hallucinations B. Gustatory hallucinations C. Visual hallucinations D. Combination

D. Primary

A church organization asks you to work with members within your health system to develop a flu vaccine program. According to public health principles, this is an example of what level of prevention? A. Secondary B. Preventative C. Tertiary D. Primary

C. Ideas of reference

A 20-year-old Asian man who was recently diagnosed with schizophrenia is coming to your office for a follow-up appointment. During the assessment, he talks about his experience in the group home, thinking that the television is sending him messages through news anchors during the 10 p.m. evening news. What symptoms is the client describing? A. Paranoia B. Illusions C. Ideas of reference D. Neologism

C. Take her vital signs

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

D. Ibuprofen increase the plasma levels of lithium, resulting in lithium toxicity

A 34-year-old female with bipolar I disorder has remained stable on Lithium 100mg/day and Lamotrigine 100mg/day for the past five years. She recently had her wisdom teeth removed and has been taking 800 mg of Ibuprofen twice daily for pain. She arrives at your office with complaints of sedation, vomiting, diarrhea, and tremors. A. Ibuprofen increases the plasma levels of Lamotrigine, resulting in Lamotrigine toxicity. B. Lamotrigine increases the plasma levels of ibuprofen, resulting in ibuprofen toxicity. C. Lithium increases the plasma of ibuprofen, resulting in ibuprofen toxicity. D. Ibuprofen increases the plasma levels of lithium, resulting in lithium toxicity

C. Moderate cognitive impairment

A 74-year-old married white male was referred to you by her care provider for a psychiatric evaluation. She had a normal medical and neurological examination in the last 2 months. The client presents with her husband of 45 years who states, "My wife is just not the same anymore, she is irritable and ask the same questions several times, even though I've answered it many times." The client responds, "Oh, Henry, you do the same thing, it's just a normal part of getting older, and the kids think everything is fine." During the assessment, you complete the mini-mental status examination (MMSE), and the client scores 18. As the PMHNP treating the client, you know the results of her MMSE indicate which level of cognitive impairment? A. No cognitive impairment B. Mild cognitive impairment C. Moderate cognitive impairment D. Severe cognitive impairment

C. Call the hospitalist and provide education that competency is a legal concept and explain that you can assess the patient for the capacity to make medical decision.

A PMHNP who is working on the consult liaison serve is referred to a patient in the medical intensive care unit by the attending hospitalist. The consult note read "Evaluate the patient for competency to make independent medical decisions and consent for a surgical procedure." Based on the scope of practice of a PMHNP, which response would be most appropriate? A. Complete the patient assessment and write up up the findings in the patient's medical record. B. Complete a patient assessment, including a mini mental status examination and family collateral data to determine competency. C. Call the hospitalist and provide education that competency is a legal concept and explain that you can assess the patient for the capacity to make a medical decisions. D. Refuse the consult and inform the hospitalist that this is outside your scope of practice.

D. Order a comprehensive metabolic panel

A client comes into the clinic with a longstanding hx of depression and chronic renal failure. He is on an antidepressant and a diuretic and complains of increase depression, mild confusion, irritability, and overall apathy from being too tired to do anything. The best initial PMHNP action to take at this time is A. Increase his dose of antidepressant medication to better capture symptoms B. Change him to another antidepressant for better symptom control C. Augment his antidepressant with an atypical antipsychotic medication D. Order a comprehensive metabolic panel

B. Early childhood

A client is displaying low self-esteem, poor self-control, self-doubt, self-doubt, and a high level of dependency. These behaviors indicate developmental failure in which of the following stages of development? A. Infancy B. Early childhood C. Late Childhood D. School age

B. Hypothalamus

A client presents with a change in appetite, feeling fatigued,. problems with sleep-cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? A. Thalamus B. Hypothalamus C. Limbic system D. Hippocampus

C. She is becoming hypomanic.

A client returns for a follow-up appointment 3 weeks after starting on fluoxetine 20 mg. During this appointment, you notice that her speech is a little rapid, in marked contrast to the psychomotor retardation and paucity of spontaneous speech she displayed on her first visit. Instead of looking at the floor, she now makes normal eye contact. Her effect has gone from constricted to expansive. She continues to have difficulty sleeping, but her energy has improved, and she states she feels "so much better!" What should you conclude about the shift in the client's presentation? A. She is experiencing the activating side effects of fluoxetine. B. She is becoming euthymic. C. She is becoming hypomanic. D. She is in a mixed state

B. "Tell me what you mean by 'it would be simpler if you just weren't there anymore."

A client says to the PMHNP. "some days life is just not worth it. All my wife and I ever do are 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 is A. "Do you mean that you are thinking about leaving your wife and moving on?" B. "Tell me what you mean by 'it would be simpler if you just weren't there anymore." C. "So you are thinking suicide might be an option for you?" D. Remain silent

B. "I know you are feeling very uncomfortable, let's take your vitals signs and talk about a trail of Catapres to treat your withdrawal.

A client who has been addicted to opioids has not been used in 15 days. During your medication management visit, the client states, "I'm going to die from not having Opanas. You need to give me something now." The PMHNP's best response is: A. " I know you are feeling very uncomfortable, and we need to get you to the emergency room immediately to prevent seizures. B. "I know you are feeling very uncomfortable, let's take your vitals signs and talk about a trail of Catapres to treat your withdrawal. C. "You have been using Opana for a long time, and it is going to take several months for the withdrawal to end. In the meantime, I will see you weekly. D. 'There is no treatment for opioid withdrawal; you will have to wait it out."

A. Frontal lobe

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 A. Frontal lobe B. Temporal lobe C. Parietal lobe D. Occipital lobe

A. Autonomy

A client with Bipolar I Disorder presents to your PMHNP office for a follow-up visit. During the visit, the client informs you that he n longer wants to be treated with medication, and he does not have bipolar disorder, that was a misdiagnosis. He further informs you that he stopped all his medication 2 months ago and is here to thank you for the care and tell you that he no longer needs to follow up appointments. Understanding the ethical conflict, you use which of the following ethical principles in working with this client? A. Autonomy B. Nonmalefience C. Justice D. Beneficence

A. Primary Prevention

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? A. Primary Prevention B. Secondary Prevention C. Tertiary Prevention D. Protective Factorial Prevention

B. Rett syndrome

A mother brings in her 7-year-old son for a psychiatric follow up with the PMHNP. This is the fourth 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. You notice that she is slapping. Renee has also lost her language skills. What medical condition do you suspect Renee has developed? A. Autism spectrum disorder B. Rett syndrome C. Selective mutism D. Childhood onset diabetes

B. Yes, the PMHNP has a duty to report.

A new client reveals to the PMHNP that her boyfriend screams at her and has repeatedly slapped and pushed her in front of her 3-year-old son. She goes on to say that the boyfriend has thrown things at her and, on one occasion, threw a glass of water at her that hit her son in the back. Should the PMHNP report this to child protective services (CPS)? A. Yes, the client is issuing a cry for help for her son. B. Yes, the PMHNP has a duty to report. C. No, this does not constitute a reportable offense. D. No, a report to CPS will escalate the violence.

B. Diagnostic criteria are used to inform clinical judgment

According to the DSM-5, which of the following is true? (Ch. 3) A. A mental disorder is equivalent to the need for treatment B. Diagnostic criteria are used to inform clinical judgment C. Socially deviant behavior is considered a mental disorder D. A culturally expected response to a stressor is not a mental disorder.

A. "You are correct that you cannot form a new brain cells at your age but you should continue with your activities because they offer excellent physical and mental health benefits and in turn will lower your risk of dementia."

Alice is a 68-year-old woman who presents to you with concerns about her memory. She explains that her mother and grandmother both experienced dementia, and she wants to do what she can to prevent this terrible disease. Alice is treated for HTN, which is well-controlled; other than that, she is in good health. She is socially and physically active and participates in a monthly cooking class, volunteers at her church, and plays bridge twice a week at the senior center. She says, "I understand that I am losing my brain cells at my age, but I would still like to keep my mind and body active." Which is the best response to Alice? A. "You are correct that you cannot form new brain cells at your age, but you should continue with your activities because they offer excellent physical and mental health benefits and in turn, will lower your risk of dementia." B. "Although most brain development occurs early in life, we still form some new brain cells in a couple of areas of the brain during adulthood. You should continue with your activities because they offer excellent physical and mental health benefits and are neuro-protective. C. "Scientists now know that we do continue to form new brain cells throughout the entire brain during adulthood. Continue with your activities because you are producing new brain cells in the frontal lobe, and this will decrease your risk of dementia." D. "You should continue the social activities such as bridge, volunteering, and the book club but should consider the risk and benefits of physical activities such as dancing. If you were to fall and break a hip, this could lead to prolonging hospitalization, loss of independence, and ultimately increase your risk of dementia.

D. Suppression

An example of a mature, healthy defense mechanism is A. Denial B. Rationalization C. Repression D. Suppression

A. Hope

As a PMHNP working in an outpatient addiction clinic, you often refer your clients to community AA and NA meetings. Using Yalom's therapeutic factors, you are aware that peer-led groups can inspire and encourage other group participants. Which therapeutic factors is instilled in AA and NA group members? A. Hope B. Altruism C. Catharsis D. Existential factors.

C. Safety of the client and others

As a PMHNP working in crisis evaluation center, you are aware that the initial focus of crisis assessment is on which of the following? A. Client's past diagnosis and medication trials B. Psychosocial history and supports C. Safety of the client and others D. Current living situation and coping

A. Risk of 1-year mortality

As a PMHNP working on the consult liaison team, you know the importance of preventing delirium due to which of the following? A. Risk of 1-year mortality B. Risk of harm to the client and staff C. Risk of unremitting psychosis D. Risk of aspiration

B. Alcohol use disorders

As a PMHNP, you understand the genetic factors that continue to cause psychiatric and personality disorders often are raised in families with high rates of which of the following? A. Psychotic disorder B. Alcohol use disorders C. Anxiety disorders D. Mood disorder

C. Used to resolve a conflict

Defense mechanisms are best viewed as a function of the ego. A. To alert us to harm and danger B. To alert us to problems C. Used to resolve a conflict D. Used to protect the id

A. Radical acceptance and change

Dialectical behavioral therapy (DBT) affirms dialectical thinking, which involves examining and discussing opposing ideas to find the truth. This philosophy is a supportive principle of DBT training. The central dialectical pattern emphasized in DBT involves the tension between. A. Radical acceptance and change B. Cue exposure and block avoidance C. Problem avoidance and problem-solving C. Crisis survival and acceptance

A. Skills training and exposure

Dialectical behavioral therapy (DBT) draws on cognitive theory and behavioral theory, along with other theories. Elements of behavioral theory in DBT include which of the following? A. Skills training and exposure B. Examination of feelings and relating feelings to visceral sensation. C. Working through the transference with the therapist D. Cognitive interpretation of past traumatic experiences

D. Substantia nigra

Dopamine is produced in which of the following locations: A. Locus Ceruleus B. Nucleus basalis C. Raphe nuclei D. Substantia nigra

C. Serum glucose or hemoglobin A1c, lipid profile, weight, body mass index, blood pressure, waist circumference, and family hx of cardiovascular disease.

Following evidence-based (EB) practice, which laboratory screening tests and assessments should be completed prior to placing a person on a second-generation ("atypical") antipsychotic medication? A. Serum glucose, lipid profile, weight, blood pressure, waist circumference, and family hx of cardiovascular disease. B. Comprehensive metabolic panel, body mass index, CBC, and thyroid panel. C. Serum glucose or hemoglobin A1c, lipid profile, weight, body mass index, blood pressure, waist circumference, and family hx of cardiovascular disease. D. Serum glucose, CBC, assessment of family hx of cardiovascular disease and cancer.

B. Deflate grandiose thoughts.

For a client who has a paranoid personality disorder, what are the best treatment strategies? A. Confront negative and misinterpreted thoughts and feelings. B. Deflate grandiose thoughts. C. Engage the client in detailed and emotional responses and dialog D. Do not challenge negative views or recollections of events.

A. Equity and efficiency

Healthcare economics are concerns with making decisions so the benefits outweigh the cost of resource utilization. What are two concepts that healthcare economics is concerned with in regard to fair distribution of resources and allocation? A. Equity and efficiency B. Cost and benefits C. Opportunity and waste D. Affordable and quality

B. Solution-focused therapy

In an attempt to bring the client toward the goal he or she is working on, you ask the client, "if a miracle were to happen tonight while you slept, and you awoke in the morning and the problem no longer existed, how would you know, and what would be different? "This technique is used in which type of therapy? A. Behavioral therapy B. Solution-focused therapy C. Adlerian therapy D. Existential therapy

D. Unable to interpret the finding without knowing the client's age

In assessing a client, you ask him the meaning of the proverb "People who live in glass houses shouldn't throw stones." He replies, "Because it will break windows." The correct interpretation of this finding is A. Client has a probable mood disorder. B. Client has a probable anxiety disorder C. Client has limited intellectual ability D. Unable to interpret the finding without knowing the client's age

C. Liver function

In completing the PMHNP assessment for Mrs. Shea, the most appropriate lab test for the PMHNP to order at this time is A. CBC B. TSH C. Liver function D. Electrolyte panel

C. Pacemaker

In considering whether to order an MRI of the head for a client, which of the following would be a contraindication to this diagnostic test? A. Prosthetic limb B. Hx of head trauma C. Pacemaker D. Pregnancy

C. Authenticity

In forming a therapeutic relationship with clients, the PMHNP must consider developing many characteristics that are known to be helpful in relationship-building. Which of the following is an essential part of building a therapeutic relationship? A. Collecting a family history B. Like-mindedness C. Authenticity D. Accuracy in assessment

C. Code with the major psychiatric disorder

In the Diagnostic and Statistical Manual of Mental Disorder, 5th Edition (DSM-5), how should a personality disorder be coded? C. Code with the major psychiatric disorder B. Coded on Axis II C. Coded Axis III Coded =on Axis IV

D. "Jason, help me understand what's going on so we can figure out how to proceed."

Jason misses several appointments. The PMHNP notes feels resentful toward Jason and is struggling with how to respond to Jason when he finally comes in for his appointment. Which of the following demonstrates a therapeutic response? A. "Jason, since you have missed several appointments, we are closing your case." B. "Jason, it's pretty clear to me that you don't want to be here." C. "Jason, you are ambivalent about seeking treatment." D. "Jason, help me understand what's going on so we can figure out how to proceed."

B. "John, thank you for asking the question. The light you see in the upper corner of my door tells me when a client has arrived and is in the waiting room. The client turns on the light, as you do, when they arrive in the waiting room, alerting me their arrival, and I turn off the light when we get into the office using the switch by my desk."

John, a client with paranoid personality disorder, states the following: " I notice there is a red light in the upper corner of your door, and it has been going on and off during our sessions. Are you recording me? What is the PMHNP's best response? A. "No, it would be illegal for me to record you, and that is not a camera it's just a red light." B. "John, thank you for asking the question. The light you see in the upper corner of my door tells me when a client has arrived and is in the waiting room. The client turns on the light, as you do, when they arrive in the waiting room, alerting me of their arrival, and I turn off the light when we get into the office using the switch by my desk." C. "Come on, John, do you think I would record your session? You are not that interesting I'm just kidding, no John, it is not a recorder or camera." D. "John, it takes courage to ask me the question. tell me a time in your life when you had a similar experience.

D. Just Culture

Mary is a Psychiatric-Mental Health Nurse Practitioner (PMHNP) who is working in a hospital role. Mary has encountered over five incidences in which attending psychiatrist and medical resident 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

A. Obstructive sleep Apnea (OSA).

Mr. D. is a 35-year-old, married, high-tech industry executive who is referred to the PMHNP for "insomnia." Mr. D. reports that he falls asleep quickly but has difficulty staying asleep. He awakes up several times during the night and believes he tosses and turns even when he is sleeping. He wakes up feeling exhausted and drinks "a pot of coffee" to stay awake and concentrate during his long work day. He drinks 1 glass of wine most evenings. He denies any illicit substance use. He denies any symptoms of a mood or anxiety disorder but is feeling increasingly frustrated and concerned about sleep. Which of the following is the most likely contributing factor to Mr. D's ongoing middle insomnia? A. Obstructive sleep Apnea (OSA). B. Caffeine dependence C. Alcohol withdrawal D. Attention-deficit hyperactivity disorder (ADHD)

A. Immature regressive defense mechanism

Mr. Johnson is a 54-year-old client you have been seeing for several weeks in therapy. While discussing his current concerns of marital stress, he lies on the floor and assumes the fetal position. This most likely an example of A. Immature regressive defense mechanism B. Denial of reality C. Immature fantasy defense mechanism D. Repressive behavior

C. In a quiet place but public enough to get assistance with client care should it be required during assessment

Mr. Johnson is a client newly admitted to an inpatient psychiatric hospital. The PMHNP on call at the facility plans to perform the initial intake assessment and diagnostic process. Mr. Johnson asks to please talk in his room because, he says, "people make me nervous." His room is at the end of the hallway and is the furthest away from the nursing station. The PMHNP's action should be based on the awareness that the best location to do the assessment is A. In Mr. Johnson's room because it is the least noisy and most comfortable for him, thus facilitating data collection. B. In the dayroom, which is full of people, to observe his interactions with other people C. In a quiet place but public enough to get assistance with client care should it be required during assessment D. In the treatment room with the door closed, a neutral location

C. Psychiatric clients can refuse treatment

Mr. Smithers, an involuntarily hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered medication because he believes "Jesus Christ told me I am the prophet and must fast for a year." Your actions should be based on you knowledge of which of the following A.Psychiatric clients cannot refuse treatments B. Psychiatric clients do not always know what is good for them C. Psychiatric clients can refuse treatment D. Psychiatric clients cannot be trusted so make good healthcare decision and, therefore, the nurse's best clinical judgement should guide actions.

B. Psychic determinism principle

Mr. Thompson has been forgetful lately, for example, forgetting where he has placed his keys or what time appointments are scheduled, and he has stated that he thinks these are just random behaviors that have no particular meaning. Which Freudian-based psychodynamics principle assumes that all behavior and actions are purposeful? A. Please principle B. Psychic determinism principle C. Reality principle Unconsciousness principle

C. A sign of normal resistance to termination seen in the termination phase of therapy

Mrs. French has been in individual therapy for 3 months. She has shown much growth and improvement in her functioning and insight and is to discontinue services within the next few weeks. In her functioning and insight, and is to discontinue services within the next few weeks. In the next session, after you discuss service termination, she suddenly begins to demonstrate the original symptoms that had brought her to treatment initially. She is now hesitant to discharge, wants to continue services, and is displaying an increase in regressive defense mechanisms. What is the best explanation for Ms. French's behavior? A. An exacerbation of her symptoms related to stress. B. The normal cyclic nature of chronic mental health symptoms C. A sign of normal resistance to termination seen in the termination phase of therapy D. A sign of pathological attachment to the therapist that must be addressed.

B. Explain that the client cannot leave until you can complete further assessment

Mrs. Kemp is voluntarily admitted to the hospital. After 24 hours, she states she wishes to leave because "this place can't help me." The best nursing action that reflects the legal right of this client is A. Discharge the client B. Explain that the client cannot leave until you can complete further assessment C. Allow the client to leave but have her sign forms stating she is leaving against medical advice D. Immediately start the paperwork to commit the client and to allow you to treat her against her wishes.

A. Ask Mrs. Shea how to help her.

Mrs. Shea has come to the mental health center seeking treatment for depression. She has a history of a suicide attempt by overdose 1 months ago. She was started on imipramine (TCA) after that event but stopped taking the medication 1 week later because it "did no good." The PMHNP meets with Mrs. Shea to plan care with her. Which of the following is the most appropriate initial action? A. Ask Mrs. Shea how to help her. B. Providing client teaching about the long time frame for TCAs to work. C. Contracting with Mrs. Shea for 6 sessions of individual therapy D. Providing Mrs. Shea with feedback about how suicide might affect her family

A. Use of a standardized rating scale of depression

Ms. Thomas has been diagnosed with major depressive disorder (MDD) and is placed on fluoxetine 20 mg for her depression. For the PMHNP to effectively monitor her use of the medication, which of the following action should be part of ongoing care? A. Use of a standardized rating scale of depression B. Monitor for potential abuse of the medication C. Monitor of labs for renal functioning D. Monitor for potential cardiac side effects

C. Accountable Care Organization (ACO)

One of the health care changes that has occurred as a result of the affordable care act (ACA) is that doctors/hospitals/clinic group or health system are coming together and assuming the responsibility for quality care to large groups of individuals insured by Medicare. The healthcare clinic/system doctors or hospital that join together are called which of the following? A. Health Maintenance Organization (HMO) B. Preferred Provider Network (PPO) C. Accountable Care Organization (ACO) D. Individual Health Plan (IHO)

C. Describing information with very little affect variation

Persons with an obsessive-compulsive personality disorder often use isolation as a defense mechanism. Which of the following examples best describes isolation as a defense mechanism? A. Staying in the house for days or weeks to clean. B. Declining invites by friends or family to attend social gatherings. C. Describing information with very little affect variation D. Being an introvert in work setting to prevent talking with coworkers.

D. Parenting skills class for pregnant adolescents.

Primary prevention care practices are an essential aspect of the PMHNP's role. Which of the following is the best example of a primary prevention care strategy for community behavioral health? A. Aftercare program for chronically mentally ill clients recently discharged from the hospital. B. Court-ordered counseling for abusive parents C. 24-hour crisis hotline. D. Parenting skills class for pregnant adolescents.

B. She likely had a traumatic event in her childhood, and her thoughts and feelings related to the event are locked together in her brain and cannot be accessed.

Samantha is a 26-year-old partnered woman who works full-time as a teacher. She is in a long-term relationship with Mary, and they are getting along well and doing well financially. They have two children, ages 2, and 6. Samantha is seeing the PMHNP to address her concerns that she is feeling down and sad for no reason and states, " I know my life is going well, but I just don't feel happy. I have always worried a lot and have been sad most of my life." As a PMHNP trained in transactional analysis (TA), you understand that personality is multifaceted and wonder which of the following is affected her ability to experience happiness. A. She had long periods of separation from her primary caregiver as a child and now has a difficult time accepting and receiving love and experiencing happiness. B. She likely had a traumatic event in her childhood, and her thoughts and feelings related to the event are locked together in her brain and cannot be accessed. C. Her unhappiness is likely related to distorted thoughts and feelings about her relationship D. As an adolescent, she experienced an event that was processed in an ego state as an older sibling.

B. Propranolol

Sarah presents for her initial intake appointment with complaints of depression. She is being treated for HTN and asthma by her PCP. Knowing that certain medications can cause or exacerbate depression, you obtain a complete medication history. Which of the following medication is known to exacerbate or cause depression? A. Omeprazole B. Propranolol C. Levothyroxine D. Clarithromycin

A. Benzodiazepine causes memory problems and confusion in clients with a hx of TBI.

Sean is a 47-year-old Gulf War veteran who was in combat during Operation Desert Storm. Sean has been treated by the PMHNP for major depressive disorder and associated anxiety symptoms. During the most recent visit, the PMHNP learned that Sean sustained a traumatic brain injury during his service, which was recently diagnosed at the TBI clinic in the VA clinic. What is the rationale for the PMHNP to taper Sean off Clonazepam? A. Benzodiazepine causes memory problems and confusion in clients with a hx of TBI. B. Benzodiazepine lowers the seizure threshold in clients with a hx of TBI, C. Veterans Affairs has banned BZO from the medication formulary. D. Benzodiazepine places clients with TBI at risk for a second head injury

C. Raphe nuclei

Serotonin is produced in which of the following locations: A. Locus ceruleus B. Nucleus basalis C. Raphe nuclei D. Substania nigra

A. Increase sensitivity to external stimuli

Signs and symptoms of cannabis intoxication include: A. Increase sensitivity to external stimuli B. Enhance motor skills. C. Fast passage of time. D. Lower Heart Rate.

B. "Maybe that depends on what you are trying to accomplish"

The PMHNP is planning to work with the client using an individual therapy model of care. During the first session, the client makes the following statement: "This is the third time my son has run away. I've grounded him, taken away his bike, and even tried cutting his allowance and confining him to his room. What should I do know?" The most therapeutic response for the PMHNP is making is A. "I wonder if confining him to his room was abusive?" B. "Maybe that depends on what you are trying to accomplish." C. "Perhaps talking to his friends and teachers would help." D. Remain silent

D. Quality improvement initiative

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? A. Needs assessment project. B. Plan, do study act project C. A task that is outside of the PMHNP's scope of practice D. Quality improvement initiative

B. Identification of specific, precise, and individualized symptoms reasonably expected to improve with medication

The concept of target symptom identification is best explained as A. Identification of the major clinical presentation of the client. B. Identification of specific, precise, and individualized symptoms reasonably expected to improve with medication C. Identification of the secondary messenger system syndrome D. Intentional modulation of the synaptic pathways.

C. Identify the mental health needs of the client

The goal of the psychiatric assessment process performed by the PMHNP is to A. Gain an understanding of the life experience of the client B. Correctly diagnose the client C. Identify the mental health needs of the client D. Be able to communicate with other staff about the client's health needs

D. Glutamate

The primary excitatory neurotransmitter is A. GABA B. Serotonin C. Dopamine D. Glutamate

A. Define the role and action of the NP

The purpose of the American Nurse Association's Psychiatric-Mental Health Nursing Scope and Standards of Practice is to: A. Define the role and action of the NP B. Established the legal authority for the prescription of psychotropic medications. C. Define the legal statutes of the role of the PMHNP D. Defines the difference between the physician role and the NP role

A. A communication medium

The role of neurotransmitters in the central nervous system is to function as A. A communication medium B. A gatekeeper for transmissions C. A building block for amino acids. D. An agent to break down enzymes

C. Pharmacokinetics

The study of what the body does to the drug is called A. Pharmacodynamics B. Pharmacology C. Pharmacokinetics D. Distribution

B. Protect the person's freedoms of right when he or she is committed to a mental hospital.

The trend in legal rulings on cases involving mental illness over the past 25 years has been to A. Encourage to find defendants not guilty by reason of insanity. B. Protect the person's freedom of right when he or she is committed to a mental hospital. C. Place increasing trust in mental health professionals to make good and ethical decisions. D. Decrease the "red tape" associated with communication so that commitments are faster and easier

D. Antiretroviral therapy

What is the best treatment for AIDS dementia complex? A. Acetylcholinesterase inhibitors. B. Symptom-targeted pharmacological treatments. C. Non-pharmacological treatments D. Antiretroviral therapy

D. Hypoglossal

When conducting a neurological examination on a client, the PMHNP asks the client to hold out her arms and stick out her tongue while assessing for tremors. Which cranial nerve is being assessed? A. Glossopharyngeal B. Vagus C. Trigeminal D. Hypoglossal

A. Black box warning about increase suicidality in this population.

When prescribing a selective serotonin reuptake inhibitor (SSRI) for a child or young adult up to age 24, what education must be included? A. Black box warning about increased suicidality in this population. B. Black box warning about increased risk of mania in this population C. Risk of sexual side effects on this class of medication D. Risk of stomach upset and headaches, to prevent unnecessary primary care visits.

C. Call the client's primary care provider, explain the situation, and coordinate the client getting an appointment and medication refills.

Tim is board certified PMHNP working in a busy community mental health center (CMHC). He is currently seeing a client diagnosed with bipolar I disorder who has comorbid hypertension and diabetes. During the visit, Tim takes the client's blood pressure, and her reading is 160/94 mm Hg. the client denies any headaches, nausea, chest pain, or shortness of breath. The client states, "I can't afford these medications so I haven't seen my doctor in 7 months, and I am out of all my blood pressure and sugar medications, can you give me some? What is Tim's most appropriate action? A. Call the pharmacy to find out what medication the client is taking and refill for 1 month to cover until she can get in to see his primary care provider. B. Tell the client he cannot refill her medication and inform her to go to the emergency room should she develop any signs or symptoms of elevated blood pressure or hyperglycemia. C. Call the client's primary care provider, explain the situation, and coordinate the client getting an appointment and medication refills. D. Send the client to an urgent care clinic to get refills today.

B. The DNP is an academic terminal degree and there will not be an opportunity for Tina to be grandfather in a DNP.

Tina is a 54-year-old single white woman who has been a PMHNP for over 20 years. She is considering making an application to a Doctor of Nursing Practice (DNP) program but states, "if a DNP is required to practice I' 'll get grandfathered in, no need for me to go back to school." Following the 2008 License, Accreditation, Certification, and Education (LACE) Consensus Model for Advance Nurse Practice Registered Nurse Regulation, which statement is true? A. Tina is correct: if a DNP becomes a requirement, she will be grandfathered in and obtain a DNP degree. B. The DNP is an academic terminal degree, and there will not be an opportunity for Tina to be grandfathered in a DNP. C. Tina will be grandfathered in and obtain a DNP only if her state requires a DNP to practice as an APRN. D. The DNP is a certification, and Tina will have to take the examination to be grandfathered in to obtain a DNP.

B. Assess for family hx of cardiovascular disease and, if positive for conduction problems, order an electrocardiogram.

Tommy is an 8-year-old who presents to the PMHNP for evaluation of attention deficit hyperactivity disorder. His mother completed the Vanderbilt ADHD rating scale and brought in the Vanderbilt teaching rating scale. Both your clinical interview and the rating scale indicate that Tommy has ADHD. What assessment indicate(s) need to be completed prior to starting a stimulant? A. Get a copy of the rating scale completed by his grandparents. B. Assess for family hx of cardiovascular disease and, if positive for conduction problems, order an electrocardiogram. C. Obtain blood pressure and pulse, and begin the stimulant. D. Assess for a family hx of bipolar disorder.

A. 5HT2a receptor antagonist properties

What differentiates atypical antipsychotic medications from first-generation or typical antipsychotic medications? A. 5HT2a receptor antagonist properties B. 5HT2a receptor agonist properties C. Specific dopamine receptor 3 and 5HTa blockers. D. Dopamine receptor 2 agonist properties.

D. Duty of care, Breach of the standard of care, Injury, and Injury must be related to breach of the standard of care.

What four elements need to be present for malpractice lawsuit to be filed? A. Beneficence, Non-Maleficence, Truthfulness, and justice D. Duty of care, Breach of the standard of care, Injury, and Injury must be related to breach of the standard of care. C. Abandonment, Breach of care, Violation of ethics, and Reimbursement for poor care. D. Breach of standard of care, Deceit, and Malpractice.

C. Decrease protein binding

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? A. Decrease body fat. B. increase liver capacity C. Decrease protein binding D. Increase muscle concentration

D. Assist the client in changing dysfunctional interpersonal relationships and use immature defense mechanisms.

When working in individual psychotherapy with a client who has a personality disorder, what are the primary treatment goals? A. Change the client's personality structure and make him or her adaptable in everyday life. B. Reparent the client, following Bowlby's theoretical framework. C. Allow the client to reprocess his or her childhood trauma because all clients with personality disorders have a history of severe abuse. D. Assist the client in changing dysfunctional interpersonal relationships and use immature defense mechanisms.

B. Affirming and reflecting

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 MI. Mike made 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? A. Interrupting and reassurance B. Affirming and reflecting C. Open-ended questions and summarizing D. Clarification and data collection

C. Strategic therapy

When working with a dysfunctional family, you find that the father, Jim, worries excessively and is resistant to change. You give Jim a paradoxical directive to worry extremely well for 1 hours per day. knowing that he will like be noncompliant and thus change will occur. With this technique, you are using which type of therapy? A. Experiential therapy B. structural therapy C. Strategic therapy D. Solution-focused therapy.

B. Recognizing

Which communication technique is the PMHNP using in the following situation? Client: "Sorry I was late. I didn't realize what time it was." PMHNP: "This is the third time now that you have been late for our session. I am wondering how committed you are to our working on your problems." A. Theming B. Recognizing C. Validating D. Sequencing

A. Rationalization, isolation, and intellectualization.

Which defense mechanism are commonly used by person with Obsessive-compulsive personality disorder? A. Rationalization, isolation, and intellectualization. B. Projection, distortion, and hypochondriasis C. Regression, somatization, and dissociation D. Sexualization, displacement, and reaction formation

B. Drugs that are highly oxidized are more unpredictable than drugs that are mostly conjugated.

Which is true pharmacological treatment for anxiety in older adults? A. Course of treatment is generally shorter than for younger adults. B. Drugs that are highly oxidized are more unpredictable than drugs that are mostly conjugated. C. The therapeutic dose of SSRi is generally lower than for young adults. D. Highly lipophilic drugs have more linear eliminations in older adults.

B. Divalproex - Spina Bifida; Lithium - Epstein anomaly

Which known teratogenic effects can be caused by the common psychotropic medications divalproex and lithium? A. Divalproex - Epstein anomaly; Lithium - Cleft Lip B. Divalproex - Spina Bifida; Lithium - Epstein anomaly C. Divalproex -Limb malformations; Lithium - Seizure disorder D. Divalproex -Mental retardation; Lithium - Spina bifida

B. Balance or stability that the family returns to despite its dysfunction

Which of the following best describes homeostasis in a family system? A. Choice a family makes to keep the peace. B. Balance or stability that the family returns to despite its dysfunction C. Need for change and balance in a family D. Calm in a family that returns after a crisis

B. Group members begin to model aspects of other members of the group and group leaders.

Which of the following client statement best describes imitative behavior as a therapeutic factor in group therapy? A. Group members talk over one another, so the loudest person is heard. B. Group members begin to model aspects of other members of the group and group leaders. C. Group members discuss a past situations when they were bullied and felt ashamed. D. Group leaders take charge of the group and redirect members when they monopolize the group.

A. Offering brief supportive psychotherapy

Which of the following interventions by the PMHNP for a person experiencing ataque de nervios demonstrates culturally informed care? A. Offering brief supportive psychotherapy B. Offering a brief hospitalization C. Request a family member act as an interpreter D. Offering low-dose, short-term anxiolytic medication

B. Identify the mental health need of the client.

Which of the following is a function of the psychiatric interview? A. Understand the client's psychosocial needs and communicate them to the treatment team. B. Identify the mental health need of the client. C. Review previous medical records. D. Evaluate a treatment plan.

A. Recognize and changes his or her automatic thoughts

Which of the following is the best rationale for using cognitive behavioral therapy? A. Recognize and changes his or her automatic thoughts B. See reality as you see it C. Change his or her reality by changing his or her environment D. Recognizes and accept that automatic thoughts suggest delusional thinking

C. Safe use in suicidal overdose clients.

Which of the following is the best reason for considering the SSRI among the first-line drug choices for treating major depression? A. Need to stair-step initial dosages. B. Sedating and calming effect of the medication C. Safe use in suicidal overdose clients. D. Ability to obtain therapeutic serum drug levels

A. In the N-C relationship, the primary goal is on the client and the client's needs.

Which of the following statements best reflects the difference between the nurse-client (N-C) relationship and a social relationship? A. In the N-C relationship, the primary goal is on the client and the client's needs. B. Goals in the N-C relationship are deliberately left vague and unspoken so the client can work on any issue. C. In the N-C relationship, the nurse is solely responsible for making the relationship work. D. In the N-C relationship, there is no place for social interaction.

C. It enables participation to acquire therapeutic factor

Why is group therapy beneficial? A. it assists the client in focusing on self B. it lacks a theoretical framework C. It enables participation to acquire therapeutic factors D. It is always time-limited

B. Moderate withdrawal

You are a PMHNP working in a hospital role on an acute inpatient psychiatric unit at a local hospital. As you make rounds, the registered nurse informs you that a 32-year-old client who was admitted for alcohol detox has a score of 17 on the CIWA-Ar. What phase of withdrawal is the client in? A. Mild withdrawal B. Moderate withdrawal C. Severe withdrawal. D. Delirium tremens

A. "The CDC and Prevention recommends the Human Papilomavirus (PVV) vaccine for all boys and girls at age 10. HPV can cause CA in both M/F, and the vaccine is effective in protecting against the virus. Can you tell me your concerns about Tim getting this vaccine?

You are the PMHNP treating Tim, a 10-year-old, for ADHD and social anxiety. His mother presents with Tim for his scheduled individual therapy session. At the end of the session, his mother says, "I need to take Tim to see his pediatrician, and at the last visit, I was told he needed some HPV shot. I don't know, he's a boy, why would he need that? What do you think?" What is the PMHNP's best response to her question? A. "The CDC and Prevention recommends the Human Papilomavirus (PVV) vaccine for all boys and girls at age 10. HPV can cause CA in both M/F, and the vaccine is effective in protecting against the virus. Can you tell me your concerns about Tim getting this vaccine? B. "While the CDC and Prevention recommend the vaccine, every parent has the right to choose and if you do not think Tim needs this vaccine, as his parent you have the right to refuse. C. "The CDC and Prevention recommends the Human papillomavirus (HPV) vaccine for older teenagers, starting at age 18, so have time to research and think about your decision. D. "My daughters received the vaccine, and I'm like you, I did not let son receive the vaccine. They don't need it. I agree, vaccine can be scary, can you tell me your concerns?'

B. Bulimia nervosa

You are training Timothy, a 16-year-old, for an eating disorder. Timothy is of normal weight and socially extroverted, at times appearing to seek attention when in a peer group or class. Timothy's symptoms are most consistent with which eating disorder? A. Anorexia nervosa B. Bulimia nervosa C. Binge eating disorder D. Anxiety-induced eating disorder

A. Excessive talking, increase activity, and distractibility.

You are treating a 14-year-old female for attention-deficit hyperactivity disorder (ADHD) who has a family hx of bipolar disorder. As a PMHNP familiar with symptoms of both ADHD and pediatric bipolar disorder, you know the following are overlapping symptoms of both. A. Excessive talking, increase activity, and distractibility. B. Irritability, sleep problems, and mood swings C. Excessive talking, irritability, and sleep problems D. Sleep problems, mood swings, and distractibility

B. Absolute neutrophil count of less than 1,000/uL

You are treating a client with schizophrenia who takes clozapine. Which laboratory values will indicate the client needs to discontinue treatment? A. WBW of less than 1,800/mm3 and absolute neutrophils count of less than 1,200/mm3. B. Absolute neutrophil count of less than 1,000/uL C. WBC count of less than 1,200/mm3 D. Absolute neutrophil count of less than 2,000/uL

C. Strategic

You are working with a family: mother, father, and two biological children. Sam, the father, is very rigid and controlling , which seems to be out of fear that something might happen to his family. He worries daily and it affects his family relationships. You give Sam a paradoxical directive and instruct him to intensely worry about everything he can think of for 1 hour a day. Using a paradoxical directive is part of which therapy? A. Experimental B. Structural C. Strategic D. Cognitive

D. "Sound like having expensive things is important to you."

You have been working with Cody, a 30-year-old man, in weekly individual psychotherapy for 3 weeks. At the start of session 4 he says, "I notice when I came in that your usual parking spot has a new car in it with temporary tags, and it's a BMW. Nice Car." What is the best response from the PMHNP psychotherapist to Cody? A. "Thank for noticing, it is a nice car. B. "How do you know what spot I park in?" C. "I noticed you drive a BMW as well, how do you like your car?" D. "Sound like having expensive things is important to you."

C. Negative symptoms

You have been working with a 54-year-old man who has been treated for schizophrenia since age 19. He has limited social interactions, like to be alone, and has never dated nor had a desire to date. His symptoms are best explained by which of the following: A. Antisocial personality disorder. B. Lack of personal hygiene. C. Negative symptoms D. Positive symptoms

C. Tolerance

Your client Sam is being treated for panic disorder with agoraphobia. He is currently being prescribed paroxetine (Paxil CR, 37.5 mg q.d) and clonazepam (klonopin, 0.5 mg 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? A. Kindling B. Addiction C. Tolerance D. Potency