Scientific Foundation

Single nucleotide polymorphisms (SNPs) detect single based changes in DNA sequence. 1. True 2. False

.Hide Explanation Correct answer: True Single nucleotide polymorphisms detect single based changes during the DNA sequencing process. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 75.

Which statement is true regarding bipolar disorder and pregnancy? 1. A Clonazepam (Klonopin) does not carry an increased risk of major fetal malformations 2. B Divalproex sodium (Depakote) is a safe alternative to lithium carbonate 3. C Lithium (Lithane, Lithobid) is safe during the first and third trimesters 4. D Carbamazepine (Tegretol, Carbatrol, Equetro) is a safe alternative to lithium carbonate

Correct answer: Clonazepam (Klonopin) does not carry an increased risk of major fetal malformations Commonly used mood-stabilizing medications for bipolar disorder carry an increased risk of major fetal malformations. However, clonazepam, lorazepam, and alprazolam are effective in the management of acute manic episodes as an adjuvant to maintenance therapy in lieu of antipsychotics. As an adjuvant to lithium or lamotrigine, clonazepam may result in increased time between cycles and fewer depressive episodes. During the first trimester, the use of lithium (Lithane, Lithobid) increases the risk of fetal cardiac malformations to 7.7%. Lithium can be used in the second and third trimesters, but it must be stopped peripartum due to the rapid fluid shifts during birth. Both carbamazepine (Tegretol, Carbatrol, Equetro) and divalproex sodium (Depakote) increase the risk of neural tube defects. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 379, 951, 988.

All of the following are atypical antipsychotic medications except: 1. A Loxapine 2. B Clozapine 3. C Aripiprazole 4. D Ziprasidone

Correct answer: Loxapine Loxapine is a typical antipsychotic. Other typical antipsychotics include the following: o Haloperidol o Thioridazine o Molindone o Thiothixene o Fluphenazine o Mesoridazine o Trifluoperazine o Chlorpromazine o Perphenazine Clozapine, ziprasidone, and aripiprazole are atypical antipsychotics. Other atypical antipsychotics include the following: o Risperidone o Quetiapine o Olanzapine o Paliperidone o Iloperidone o Asenapine o Lurasidone Reference: Johnson, K., & Vanderhoef, D. Psychiatric-Mental Health Nurse Practitioner Review Manual, Fourth Edition. Pg 244-247.

A 40-year-old man diagnosed with schizophrenia presents to your office with bradykinesia, drooling, and a festinating gait. Which antipsychotic medication is least likely to cause these side effects? 1. A Haloperidol (Haldol) 2. B Olanzapine (Zyprexa) 3. C Thioridazine (Mellaril) 4. D Chlorpromazine (Thorazine)

Correct answer: Olanzapine (Zyprexa) These symptoms suggest antipsychotic-induced parkinsonism, which usually begins after several weeks of treatment. Drug-induced parkinsonism is more common in typical or high-potency antipsychotics like haloperidol, thioridazine, and chlorpromazine and is much less common in atypical or low-potency antipsychotics like olanzapine. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 972.

Which class of psychiatric medications is most likely to cause extrapyramidal side effects? 1. A Typical antipsychotics 2. B Atypical antipsychotics 3. C Second-generation antipsychotics 4. D Benzodiazepines

Correct answer: Typical antipsychotics Extrapyramidal symptoms are drug-induced side effects that affect motor functioning and muscle movement. The common types of extrapyramidal symptoms are akathisia, akinesia, dystonia, pseudo-Parkinson's, and tardive dyskinesia. Typical antipsychotics (also known as first-generation antipsychotics) are more likely to cause these side effects than atypical antipsychotics (also known as second-generation antipsychotics). Benzodiazepines do not cause extrapyramidal symptoms. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 248-249.

As a nurse practitioner, you are responsible for assessing cranial nerves as a part of the neurological exam. What cranial nerve assessment tests the strength of the sternocleidomastoid and trapezius muscles against the resistance of the provider's hands? 1. A Trigeminal nerve (sensory division) 2. B Trigeminal nerve (motor division) 3. C Facial 4. D Accessory spinal

Hide Explanation Correct answer: Accessory spinal The accessory spinal (cranial nerve XI) assessment tests the strength of the sternocleidomastoid and trapezius muscles against the resistance of the provider's hands. The trigeminal nerve (cranial nerve V, sensory division) assessment tests for tactile perception of the facial skin. The trigeminal nerve (cranial nerve V, motor division) assessment tests for masseter muscle strength. The facial nerve (cranial nerve VII, motor division) assessment checks for flaccid paralysis. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 80-81.

Delirium is known to be associated with high mortality and morbidity. Delirium is presenting more and more in the emergency room setting and is often mistaken for a psychotic emergency or event. As a nurse practitioner, you will be responsible for assessing individuals for psychosis versus delirium. Which of the following mnemonics is the correct one for assessing for delirium? 1. A o D = Dementia o E = Electrolyte abnormality o L = Low oxygen saturation o I = Infection o R = Reduced sensory input o I = Intracranial o U = Urinary or renal retention o M = Myocardial 2. B o D = Drugs o E = Electrolyte abnormality o L = Low oxygen saturation o I = Infection o R = Reduced sensory input o I = Intracranial o U = Urinary or renal retention o M = Myocardial 3. C o D = Drugs o E = Electrolyte abnormality o L = Low oxygen saturation o I = Infection o R = Reduced sensory input o I = Intracranial o U = Urinary or renal retention o M = Medications 4. D o D = Drugs o E = Electrolyte abnormality o L = Low oxygen saturation o I = Infection o R = Reduced sensory input o I = Intracranial o U = Urinary or renal retention o M = Mood

Hide Explanation Correct answer: o D = Drugs o E = Electrolyte abnormality o L = Low oxygen saturation o I = Infection o R = Reduced sensory input o I = Intracranial o U = Urinary or renal retention o M = Myocardial The other options are not correct mnemonics for assessing delirium. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 276.

At what age would you expect a child to ride a tricycle, build a tower of 10 cubes, draw a circle, put on shoes, and understand taking turns with other children? 1. A 2 years 2. B 3 years 3. C 1 year 4. D 5 years

Hide Explanation Correct answer: 3 years At three years of age, landmarks of normal behavioral development include the following: o Rides tricycle o Jumps from bottom of steps o Alternates feet going up stairs o Builds tower of 9 or 10 cubes o Imitates a three-cube bridge o Copies a circle and a cross drawing o Puts on shoes o Unbuttons buttons o Feeds self well o Understands taking turns with others Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 1087.

You are treating a patient for his first episode of major depression. You decide to initiate citalopram (Celexa). How much time should you allow for the medication to provide its initial therapeutic effect and the patient to see improvement of symptoms? 1. A 8 months 2. B 4 to 6 weeks 3. C 2 weeks 4. D 2 months

Hide Explanation Correct answer: 4 to 6 weeks The initial time frame for this medication to have a therapeutic effect is 4 to 6 weeks. Once the patient begins treatment on an SSRI, and the nurse practitioner and patient agree on the regimen, patients are expected to continue this treatment for 6 to 12 months. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 151.

At what age would you expect a child to hold his head erect for a few seconds, follow moving objects to midline, and smile preferentially at his mother? 1. A 4 weeks 2. B 12 months 3. C 28 weeks 4. D 16 weeks

Hide Explanation Correct answer: 4 weeks At four weeks, landmarks of normal behavioral development include o Hands fisted o Head sags but can hold head erect for a few seconds o Follows moving objects to midline o Responds to speech o Smiles preferentially at mother Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 1087.

At what age would you expect a child to sit alone with good coordination, imitate scribble, develop mild separation anxiety, and respond to social play such as peek-a-boo? 1. A 40 weeks 2. B 18 months 3. C 2 years 4. D 16 weeks

Hide Explanation Correct answer: 40 weeks At 40 weeks of age, landmarks of normal behavioral development include the following: o Sits alone with good coordination o Creeps o Pulls self to standing position o Points with index finger o Matches two objects at midline o Attempts to imitate scribble o Develops separation anxiety when away from mother o Responds to social play such as peek-a-boo o Feeds self a cracker and holds own bottle Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 1087.

What is the most common sexual dysfunction side effect reported by women who are prescribed a selective serotonin reuptake inhibitor (SSRI)? 1. A Anorgasmia 2. B Vaginismus 3. C Decreased sexual desire 4. D Dyspareunia

Hide Explanation Correct answer: Anorgasmia Anorgasmia is the most commonly reported sexual dysfunction side effect in women who are taking SSRIs. This is defined as the persistent inability to achieve orgasm despite responding to sexual stimulation. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 1018.

You are a nurse practitioner treating a seven-year-old male. His mother brings him in for his initial appointment with a chief complaint of, "My son's teacher is concerned about my son because he is not able to finish his in-class schoolwork. I just don't know what to do." The mother states that it has been reported that her son fails to give attention in class, gets distracted often, is disorganized with his assignments, constantly loses his homework, is always talking out of turn and distracting other students, and interrupts when other students answer a question. After performing the necessary assessments and testing, you diagnose this client with attention deficit hyperactivity disorder (ADHD), inattentive type. You decide to start him on a low-dose stimulant. Which of the following stimulants is FDA-approved for the treatment of ADHD in children? 1. A Kapvay (clonidine) 2. B Adderall (amphetamine salts) 3. C Strattera (atomoxetine) 4. D Intuniv (guanfacine)

Hide Explanation Correct answer: Adderall (amphetamine salts) The FDA has approved both stimulants and non-stimulants for the treatment of ADHD in children. Adderall (amphetamine salts) is a stimulant. The following medications are FDA-approved but are not classified as stimulants: o Strattera (atomoxetine) o Intuniv (guanfacine) o Kapvay (clonidine) Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 338.

A 47-year-old man with a history of alcohol use disorder presents to the emergency room. His family tells you that he has been "living off whiskey and nothing else for weeks." The nurse is about to draw his blood and offer him a snack. What is your next immediate action? 1. A Obtain a vitamin B12 level 2. B Administer thiamine 3. C Order lorazepam (Ativan) to be given as needed for agitation 4. D Listen for a murmur

Hide Explanation Correct answer: Administer thiamine Individuals with chronic alcohol misuse often consume most of their calories from alcohol and are at high risk for thiamine deficiency. A thiamine-deficient person can develop Wernicke encephalopathy if they attempt to metabolize food. You must administer thiamine immediately for this patient. The other choices are also important but do not require immediate action. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 796-799.

A 36-year-old Caucasian male arrives for his usual monthly medication appointment. He is diagnosed with schizophrenia and has been stabilized on haloperidol for the past nine years. Today he complains of an inner feeling of restlessness and the inability to remain still. He states, "I've been pacing around my apartment nonstop, just walking up and down the stairs." You suspect this is what type of extrapyramidal side effect? 1. A Dystonia 2. B Akinesia 3. C Akathisia 4. D Tardive dyskinesia

Hide Explanation Correct answer: Akathisia Extrapyramidal symptoms are drug-induced side effects that affect motor functioning and muscle movement. Typical antipsychotics like haloperidol, perphenazine, and chlorpromazine are more likely to cause these side effects than atypical antipsychotics like olanzapine, lurasidone, and risperidone. The common types of extrapyramidal symptoms are listed below: o Akathisia: motor restlessness, inability to remain still, rocking, pacing, or constant motion of a unilateral limb, subjective sense of restlessness, often mistaken for increasing anxiety o Akinesia: absence of movement, difficulty initiating motion, subjective feeling of lack of motivation to move, often mistaken for laziness or lack of interest o Dystonia: muscle spasticity usually in the back or neck, subjectively painful, often mistaken for agitation o Pseudo-Parkinson's: shuffling gait, motor slowing, mask-like facial expression, pill-rolling, tremors, muscle rigidity o Tardive dyskinesia: involuntary abnormal muscle movement of the mouth, tongue, face, and jaw that may progress to limbs; can be irreversible, can occur as an acute process at the initiation of medications or as a chronic condition at any point during treatment Reference: Johnson, K., & Vanderhoef, D. Psychiatric-Mental Health Nurse Practitioner Review Manual, Fourth Edition. Pg 249.

Magnesium is responsible for neuromuscular activity and excitability. An increased level of magnesium in the body is linked to all of the following illnesses except: 1. A Hypothyroidism 2. B Alcoholism 3. C Hyperthyroidism 4. D Renal failure

Hide Explanation Correct answer: Alcoholism Alcoholism is linked to decreased levels of magnesium in the body. Other diseases linked to increased magnesium levels: o Addison's disease o Diabetic ketoacidosis o Dehydration Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 92.

A decrease in serotonin is related to all of the following psychiatric disorders except: 1. A Alzheimer's disease 2. B Obsessive-compulsive disorder 3. C Major depressive disorder 4. D Schizophrenia

Hide Explanation Correct answer: Alzheimer's disease A decrease in serotonin is related to major depressive disorder, obsessive-compulsive disorder, and schizophrenia. Alzheimer's disease is related to a decreased in acetylcholine, not serotonin. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 70.

How does the body remove both serotonin and norepinephrine from the synaptic cleft? 1. A A reverse action potential 2. B An active reuptake process 3. C Diffusion off their receptors 4. D A monoamine oxidase enzymatic action

Hide Explanation Correct answer: An active reuptake process Both serotonin and norepinephrine are removed from the synaptic cleft and returned to storage via an active reuptake process. Dopamine, on the other hand, is removed from the synaptic cleft by monoamine oxidase enzymatic action. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 68-71.

In common psychiatric disorders, neurotransmitters are implicated in the complex pathophysiology of certain disease processes. A decrease in dopamine will cause an exacerbation of which disorder? 1. A Anxiety disorders 2. B Anhedonia 3. C Obsessive-compulsive disorders 4. D Psychosis

Hide Explanation Correct answer: Anhedonia Patients suffering from anhedonia present with a decrease in dopamine activity. Patients suffering from psychosis and schizophrenia present with an increase in dopamine activity. Patients suffering from anxiety disorders present with a decrease in gamma-aminobutyric acid, or GABA. Patients suffering from obsessive-compulsive disorders present with a decrease in serotonin activity. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 70.

Decreased levels of sodium (Na) can cause which of the following? 1. A Diabetes insipidus 2. B Dehydration 3. C Diuresis 4. D Gastroenteritis

Hide Explanation Correct answer: Diuresis Increased, not decreased, levels of sodium (Na) can cause dehydration, diabetes insipidus, and gastroenteritis. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 91.

A patient presents with psychosis, dry mouth, hyperpyrexia, mydriasis, restlessness, and tachycardia. What possible psychiatric emergency would you suspect? 1. A Catatonic schizophrenia 2. B Anticholinergic intoxication

Hide Explanation Correct answer: Anticholinergic intoxication Psychosis, dry mouth, hyperpyrexia, mydriasis, restlessness, and tachycardia are symptoms of anticholinergic intoxication. The nurse practitioner should discontinue the offending medication or substance and consider IV physostigmine and benzodiazepines. Remember, antipsychotics are contraindicated in this situation. Alcohol withdrawal would present with irritability, nausea, vomiting, insomnia, malaise, autonomic hyperactivity, and shakiness. Benzodiazepine intoxication would present with sedation, somnolence, and ataxia. Catatonic schizophrenia would present with marked psychomotor disturbance (either excitement or stupor) and exhaustion. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 781.

Pharmacological management of social anxiety (phobia) disorder can include all of the following treatment options except: 1. A Short-term benzodiazepines 2. B Beta-blockers 3. C Anticonvulsants 4. D SSRIs (selective serotonin reuptake inhibitors)

Hide Explanation Correct answer: Anticonvulsants Anticonvulsants are not considered first-line treatment for social anxiety (phobia) disorder. Anticonvulsants are indicated in the treatment of mood disorders such as bipolar and depression. Although anticonvulsants may be helpful in stabilizing mood disorders, which can lead to a decrease in anxiety, alone they are not indicated for social anxiety disorder. The other pharmacological management options are all indicated in the treatment of social anxiety (phobia) disorder. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 215.

The cerebrum contains all of the following areas of the brain except: 1. A Limbic system 2. B Hypothalamus 3. C Brainstem 4. D Cerebral cortex

Hide Explanation Correct answer: Brainstem The brain itself is divided into two distinct anatomical regions: the cerebrum and the brainstem. The cerebrum contains the cerebral cortex, limbic system, thalamus, hypothalamus, and basal ganglia. The brainstem includes the midbrain, pons, cerebellum, medulla, and reticular formation. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 66.

Which part of the brain is composed of the cells that produce neurotransmitters? 1. A Corpus striatum 2. B Brainstem 3. C Basal ganglia 4. D Hypothalamus

Hide Explanation Correct answer: Brainstem The brainstem is made up of the cells that produce neurotransmitters like serotonin and dopamine. The basal ganglia, also called the corpus striatum, functions in learning and automatic actions like walking and driving a car. The hypothalamus regulates appetite, water balance, circadian rhythm, body temperature, and libido. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 67.

Tanner Stages define physical measurement in the development of primary and secondary sex characteristics in both females and males. What is stage 2 of a female's breast development? 1. A Prepubertal 2. B Areola and papilla form secondary mound above the level of the breast 3. C Breast bud stage with elevation of breast and papilla 4. D Projection of papilla and recession of areola

Hide Explanation Correct answer: Breast bud stage with elevation of breast and papilla Tanner Stages define physical measurement in the development of primary and secondary sex characteristics in both females and males. Tanner Stages of a girl's breast development are as follows: o Stage 1: Prepubertal o Stage 2: Breast bud stage with elevation of breast and papilla o Stage 3: Further enlargement of breast and areola o Stage 4: Areola and papilla form a secondary mound above the level of the breast o Stage 5: Projection of papilla related to recession of areola Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 99.

A patient presents with high fever, pharyngitis, and oral and perianal ulcerations. What psychiatric emergency would you suspect? 1. A Korsakoff's syndrome 2. B Alcohol delirium 3. C Bromide intoxication 4. D Clozapine-induced agranulocytosis

Hide Explanation Correct answer: Clozapine-induced agranulocytosis High fever, pharyngitis, and oral and perianal ulcerations suggest clozapine-induced agranulocytosis. This is a psychiatric emergency. The nurse practitioner should discontinue the medication immediately and conduct a further evaluation. Alcohol delirium would present with confusion, disorientation, fluctuating levels of consciousness, and autonomic hyperactivity. Korsakoff's syndrome would present with alcohol stigmata, amnesia, and confabulation. Bromide intoxication would have a vague, diverse presentation of delirium, mania, depression, and psychosis. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 780.

Sara is a 22-year-old female who has been on the inpatient psychiatric unit for acute paranoia and delusional thought processes. Upon admission, the psychiatric-mental health nurse practitioner orders 10 mg of Haldol and 25 mg of Benadryl to be given by mouth STAT. Two hours later, Sara presents to the nurses' station complaining of severe abdominal cramps and elevated heart rate. You are the provider on call and you receive the call from the charge nurse explaining the patient's symptoms. You determine that Sara is most likely suffering from acute dystonia and order the following medication to be given STAT: 1. A Benadryl 25 mg PO STAT 2. B Klonopin 0.5 mg PO STAT 3. C Cogentin 2 mg IM STAT 4. D Cogentin 1 mg PO STAT

Hide Explanation Correct answer: Cogentin 2 mg IM STAT For acute dystonia, Cogentin 2 mg IM STAT is the best intervention, as Benadryl had previously been given without preventative effects. Cogentin 1 mg PO is a good option but not the best for treating an acute presentation. Klonopin 0.5 mg is appropriate for preventative measures but will not provide immediate relief of the acute nature of the presentation. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 76-77.

Combined structural and functional imaging attempts to examine structures in conjunction with their function. Combined structural and functional imaging is the standard of care when it comes to diagnostics, treatment, and planning. 1. A False 2. B True

Hide Explanation Correct answer: False Although combined structural and functional imaging is effective, because of cost this type of testing is often limited to research only. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 72-73.

All of the following are systemic effects of hypothyroidism except: 1. A Weight gain 2. B Constipation 3. C Compulsive movement 4. D Decreased libido

Hide Explanation Correct answer: Compulsive movement Compulsive movement is a symptom of hyperthyroidism, not hypothyroidism. Systemic effects of hypothyroidism: o Confusion o Decreased libido o Impotence o Decreased appetite o Memory loss o Lethargy o Constipation o Headaches o Clumsy movements o Syncope o Weight gain o Fluid retention o Muscle aching o Slowed reflexes Systemic effects of hyperthyroidism: o Motor restlessness o Emotional lability o Short attention span o Compulsive movement o Fatigue o Tremor o Insomnia o Impotence o Weight loss o Increased appetite o Abdominal pain o Excessive sweating o Flushing o Tachycardia o Dysrhythmias Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 88.

Common structural tests aiding in the diagnostics of brain-based disorders include which of the following? 1. A Laboratory testing 2. B X-ray 3. C Computed tomography (CT) 4. D EMDR

Hide Explanation Correct answer: Computed tomography (CT) Computed tomography provides a three-dimensional view of the brain structures and differentiates structures based on density. CT scans provide suggestive evidence of brain-based problems. X-ray testing provides minimal insight into brain-based problems and is typically used for structural diagnostics such as broken bones and the presence of fluid in organs such as the lungs. Laboratory testing is not a form of structural testing but is simply the drawing of blood for diagnostic purposes. EMDR (eye movement desensitization and reprocessing) is not a form of structural testing but a form of psychotherapy used to treat patients suffering from trauma disorders. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 72-73.

Systemic effects of hyponatremia include which of the following? 1. A Thirst 2. B Restlessness 3. C Fever 4. D Confusion

Hide Explanation Correct answer: Confusion Systemic effects of hypernatremia include restlessness, thirst, and fever. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 91.

The basal ganglia is responsible for all of the following functions except: 1. A Connecting sensory smell information with emotions 2. B Initiating complex motor function 3. C Maintaining muscle tone, posture, and common reflexes 4. D Stabilizing somatic motor activity

Hide Explanation Correct answer: Connecting sensory smell information with emotions The limbic system's amygdala, not the basal ganglia, is responsible for connecting sensory smell information with emotions. The basal ganglia stabilizes somatic motor activity, initiates complex motor function, and maintains muscle tone, posture, and common reflexes. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 67.

The somatic nervous system is responsible for which of the following? 1. A Preparing the body for stress by stimulating the activity of organs 2. B Maintaining and restoring energy by inhibiting the activity of organs 3. C Regulating internal body functions in order to maintain homeostasis and producing involuntary movement 4. D Conveying information from the central nervous system to skeletal muscles and producing voluntary movement

Hide Explanation Correct answer: Conveying information from the central nervous system to skeletal muscles and producing voluntary movement The peripheral nervous system is composed of the somatic and autonomic nervous systems. The autonomic nervous system is further divided into the parasympathetic and sympathetic nervous systems. o The somatic nervous system conveys information from the central nervous system to skeletal muscles and is responsible for voluntary movement. o The autonomic nervous system regulates internal body functions to maintain homeostasis. It is responsible for involuntary movement and is divided into the sympathetic and parasympathetic nervous systems. § The sympathetic nervous system prepares the body for stress by stimulating the activity of organs. § The parasympathetic nervous system maintains and restores energy by inhibiting the activity of organs. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 64.

Systemic effects of hyponatremia include all of the following except: 1. A Headaches 2. B Confusion 3. C Convulsions 4. D Lethargy

Hide Explanation Correct answer: Convulsions Other presentations of hyponatremia include the following: o Apprehension o Seizures o Coma o Hypotension o Tachycardia o Decreased urine output o Weight gain o Edema o Ascites o Jugular vein distension Presentations of hypernatremia: o Convulsions o Pulmonary Edema o Thirst o Fever o Dry mucous membranes o Hypotension o Tachycardia o Low jugular venous pressure o Restlessness Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 91.

Which medication can potentially cause all of the following symptoms: anxiety, mood changes, psychosis, and delirium? 1. A Benzodiazepines 2. B NSAIDs 3. C Antiulcer agents 4. D Corticosteroids

Hide Explanation Correct answer: Corticosteroids Corticosteroids are known to cause a wide range of psychiatric symptoms including anxiety, mood changes, psychosis, and delirium. Other medications that can cause all these symptoms include the following: o Analgesics o Anesthetics o Anticonvulsants o Antidepressants o Antihypertensives Benzodiazepines and antiulcer agents can cause mood changes. NSAIDs can cause psychosis. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 735.

Marijuana use during pregnancy is associated with all of the following symptoms in neonates except: 1. A Decreased desire for human contact 2. B Severe vomiting 3. C Low birth weight 4. D Withdrawal-like symptoms

Hide Explanation Correct answer: Decreased desire for human contact Marijuana is used by 3% of all pregnant women. Chronic marijuana use is associated with the following symptoms in neonates: o Low infant birth weight o Prematurity o Withdrawal-like symptoms o Excessive crying o Tremors o Hyperemesis (severe vomiting) Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 1086.

All of the following medications can induce depression except: 1. A Progesterone 2. B Propranolol 3. C Disulfiram 4. D Interferon

Hide Explanation Correct answer: Disulfiram The following common medications can induce depression: o Beta blockers such as propranolol o Steroids o Interferon o Isotretinoin o Some retroviral drugs o Neoplastic drugs o Benzodiazepines o Progesterone The following medications can induce mania: o Steroids o Disulfiram o Isoniazid o Antidepressants Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 119.

Disorganized thinking, loose associations, tics, and stereotypic behavior suggest that a patient is experiencing an excess of which neurotransmitter? 1. A Dopamine 2. B Serotonin 3. C Norepinephrine 4. D Acetylcholine

Hide Explanation Correct answer: Dopamine A dopamine excess results in symptoms of disorganized thinking, loose associations, tics, and stereotypic behavior. A dopamine deficit results in symptoms of Parkinson's disease, endocrine alterations, poor spatiality, and lack of abstract thought. A serotonin excess results in restlessness, agitation, myoclonus, and vital sign abnormalities. An acetylcholine excess results in over-inhibition, anxiety, somatic complaints, self-consciousness, and drooling. A norepinephrine excess results in hyperalertness, paranoia, and decreased appetite. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 71.

In common psychiatric disorders, which neurotransmitter is implicated in the complex pathophysiology of certain disease processes involving normal functions such as decision-making and integrated cognition? 1. A Norepinephrine 2. B Glutamate 3. C Serotonin 4. D Dopamine

Hide Explanation Correct answer: Dopamine The general function of dopamine involves normal functioning of thinking, decision-making, reward-seeking behavior, fine muscle action, and integrated cognition. Dopamine irregularities are closely linked to disease processes such as schizophrenia. The general function of norepinephrine involves alertness, orientation, fight-or-flight, learning, memory, and focus and attention. Norepinephrine irregularities are closely linked to disease processes such as panic disorders and anxiety. The general function of serotonin involves regulation of sleep, pain perception, mood states, temperature, aggression, and libido. Serotonin irregularities are closely linked to depressive disorders. The general function of glutamate involves memory and sustained autonomic functions. Glutamate irregularities are closely linked to bipolar type disorders. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 71-72.

Examples of monoamine neurotransmitters include which of the following? 1. A Dopamine, norepinephrine, and serotonin 2. B Glutamate, GABA, aspartate, and acetylcholine 3. C Endorphins, enkephalins, and dynorphins 4. D Substance P and somatostatins

Hide Explanation Correct answer: Dopamine, norepinephrine, and serotonin Neurotransmitters fall into four categories: 1. Monoamines 2. Amino acids 3. Cholinergics 4. Neuropeptides (divided into nonopioid type and opioid type) Dopamine, norepinephrine, and serotonin are examples of monoamine neurotransmitters. These are also called biogenic amines. Glutamate, GABA, aspartate, and acetylcholine are examples of amino acids. Substance P and somatostatins are examples of nonopioid-type neuropeptides. Endorphins, enkephalins, and dynorphins are examples of opioid-type neuropeptides. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 69.

The precise mechanism of action of selective serotonin reuptake inhibitors (SSRIs) remains unknown. Considering the delayed therapeutic response, one theory involves: 1. A Increased mitochondrial serotonin 2. B Up-regulation of postsynaptic 5-HT2 receptor sites 3. C Down-regulation of dopamine receptors 4. D Down-regulation of postsynaptic 5-HT2 receptor sites

Hide Explanation Correct answer: Down-regulation of postsynaptic 5-HT2 receptor sites The exact mechanism of action of selective serotonin reuptake inhibitors (SSRIs) remains unclear. Acutely, they inhibit serotonin reuptake pumps, thus increasing the amount of available serotonin in the synapse. However, patients typically do not experience symptomatic relief for several weeks. Some research demonstrates that the delayed therapeutic effects are due to a down-regulation of postsynaptic 5-HT2 receptor sites. Increased mitochondrial serotonin and up-regulation of postsynaptic 5-HT2 receptor sites are incorrect because there is no evidence that either of these things occurs. SSRIs do inhibit the dopamine system, but this is most likely unrelated to their antidepressant effect. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 1014-1015.

Mr. Smith is a 25-year-old sales associate. He has a strong family history of mental illness and is worried that he may experience problems in his life because of this. He presented to his local primary care provider complaining of the following symptoms: extreme hyper-alertness, decreased appetite, insomnia, and paranoia. Mr. Smith is worried that these symptoms might be the beginning of a mental illness and requests that an X-ray of his brain be done to see if he has a mental illness. He says he has never seen a psychiatric provider, nor has he ever taken medication for his symptoms. What would be an initial consideration in your assessment when meeting with Mr. Smith? 1. A Ensuring that Mr. Smith understands appropriate diagnostics and testing for determining a mental illness 2. B Educating Mr. Smith on his need for Wellbutrin immediately 3. C Assessing Mr. Smith for the need for voluntary inpatient admission 4. D Performing genetic testing prior to moving forward with the evaluation

Hide Explanation Correct answer: Ensuring that Mr. Smith understands appropriate diagnostics and testing for determining a mental illness Patients often misunderstand and misinterpret diagnostic testing. Explaining this first is important in moving on in the diagnostic phase so that all appropriate options for diagnosing his condition can be explored. Prescribing Wellbutrin immediately is not an appropriate initial intervention, as Mr. Smith is most likely experiencing an increase in norepinephrine. Wellbutrin is an NDRI. Although performing genetic testing may be necessary, it is often not approved by insurance after an initial visit and if the patient has not used psychotropics in the past. Mr. Smith is not a danger to himself or others and is not gravely disabled and thus does not meet criteria for inpatient admission. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 76-77.

All of the following are tricyclic antidepressants except: 1. A Clomipramine 2. B Doxepin 3. C Escitalopram 4. D Imipramine

Hide Explanation Correct answer: Escitalopram Escitalopram is a selective serotonin reuptake inhibitor (SSRI). Other SSRIs include: o Fluvoxamine o Paroxetine o Fluoxetine o Sertraline o Citalopram Clomipramine, doxepin, and imipramine are tricyclic antidepressants (TCAs). Other TCAs include: o Amoxapine o Amitriptyline o Desipramine o Nortriptyline o Trimipramine o Protriptyline Reference: Johnson, K., & Vanderhoef, D. Psychiatric-Mental Health Nurse Practitioner Review Manual, Fourth Edition. Pg 154.

A genotype is the observable characteristic of a specific trait and is connected to the genetic contributions to that trait. 1. A False 2. B True

Hide Explanation Correct answer: False A phenotype, not a genotype, is the observable characteristic of a specific trait and is connected to the genetic contributions to that trait. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 74.

Calcium values can be increased during treatment with anticonvulsants, aspirin, corticosteroids, heparin, and oral contraceptives. 1. A False 2. B True

Hide Explanation Correct answer: False Calcium values can be decreased during treatment with anticonvulsants, aspirin, corticosteroids, heparin and oral contraceptives. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 90.

Chromosomes are structures of DNA in the nucleus of the cell. There are normally 44 total (22 pairs) in humans. 1. A False 2. B True

Hide Explanation Correct answer: False Chromosomes are structures of DNA in the nucleus of the cell. There are normally 46 total (23 pairs) in humans. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 74.

Hyperprolactinemia is a milky nipple discharge unrelated to the normal milk production of breastfeeding. 1. A False 2. B True

Hide Explanation Correct answer: False Galactorrhea, not hyperprolactinemia, is a milky nipple discharge unrelated to the normal milk production of breastfeeding. Hyperprolactinemia is an indication of elevated prolactin levels, which can cause galactorrhea and is a risk factor for those taking antipsychotics, especially second-generation antipsychotics such as Invega or Risperdal. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 84-85.

Genes are a sequence of mRNA that cause human characteristics to be passed to the next generation. 1. A False 2. B True

Hide Explanation Correct answer: False Genes are a sequence of DNA, not mRNA, that cause human characteristics to be passed to the next generation. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 74.

Genes direct the production of amino acids. 1. A True 2. B False

Hide Explanation Correct answer: False Genes direct the production of proteins, not amino acids. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 74.

Magnetic resonance imaging (MRI) provides a series of three-dimensional images that represent the brain. 1. A False 2. B True

Hide Explanation Correct answer: False Magnetic resonance imaging (MRI) provides a series of two-dimensional images that represent the brain. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 72-73.

Pharmacokinetics is the term that describes what a drug does to the body when ingested and paired with the individual's enzyme activity. 1. A True 2. B False

Hide Explanation Correct answer: False Pharmacodynamics is the term that describes what a drug does to the body when ingested and paired with the individual's pharmacodynamic gene profile. Pharmacokinetics refers to what the body does to a drug when it's ingested. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 75.

Pharmacodynamics is the term that describes what the body does to a drug when it's ingested and paired with the individual's pharmacodynamic genetic makeup. 1. A False 2. B True

Hide Explanation Correct answer: False Pharmacokinetics, not pharmacodynamics, is the term that describes what the body does to a drug when it's ingested and paired with the individual's enzyme profile. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 75.

Potassium (K+) is a major extracellular electrolyte. 1. A True 2. B False

Hide Explanation Correct answer: False Potassium is involved in intracellular activity, not extracellular. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 93.

Increased penetrance of a gene decreases the chances of disease in a person who is or may be at a genetic risk. 1. A True 2. B False

Hide Explanation Correct answer: False Reduced, not increased, penetrance of a gene decreases the chances of disease in a person who is or may be at a genetic risk. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 75.

A 32-year-old male presents to your clinic with complaints of weight gain, hypersomnia, carbohydrate craving, leaden paralysis, difficulty concentrating, and anergia. He also reports feelings of sadness and emptiness. Based on this information, what would be the most effective psychiatric medication? 1. A Alprazolam 2. B Trazodone 3. C Quetiapine 4. D Fluoxetine

Hide Explanation Correct answer: Fluoxetine This patient is likely suffering from a major depressive episode with atypical features. Although atypical features respond best to monoamine oxidase inhibitors, these medications are rarely used because of their potential risk of a hypertensive crisis. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine are also beneficial and have a favorable side effect profile. Quetiapine is an atypical antipsychotic medication, and it is not indicated in the treatment of this patient's symptoms. Trazodone also inhibits serotonin reuptake, but it is not a first-line treatment and may worsen the patient's hypersomnia. Alprazolam is a benzodiazepine used in the short-term treatment of severe anxiety. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 147-153. Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 1013.

In common psychiatric disorders, neurotransmitters are implicated in the complex pathophysiology of certain disease processes. A decrease in acetylcholine will cause an exacerbation of which disorder? 1. A Psychosis from ischemic neurotoxicity or excessive pruning 2. B Parkinsonian symptoms 3. C Schizophrenia 4. D Impaired memory and/or Alzheimer's disease

Hide Explanation Correct answer: Impaired memory and/or Alzheimer's disease Patients suffering from impaired memory or Alzheimer's disease present with a decrease in acetylcholine. Patients suffering from Parkinsonian symptoms present with an increase in acetylcholine. Patients suffering from schizophrenia present with an increase in dopamine. Patients suffering from psychosis due to ischemic neurotoxicity or excessive pruning present with an increase in glutamate. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 70.

A patient of yours is presenting to your clinic with reports of excessive hand washing and feeling as if she cannot leave the house unless she washes her hands seven times for five minutes each time. The patient further explains that she often shows up for work late because her anxiety keeps her from completing the washing with enough time to get to work by her start time. You obtain further history and learn that the patient's mother had similar issues with cleaning the house. You give this patient a diagnosis of obsessive compulsive disorder. What medication will you choose to prescribe to this client? 1. A Promethazine (Phenergan) 2. B Lorazepam (Ativan) 3. C Chlorpromazine (Thorazine) 4. D Fluoxetine (Prozac)

Hide Explanation Correct answer: Fluoxetine (Prozac) Prozac is an SSRI; these are FDA-approved for the treatment of OCD. Other medications approved for OCD are as follows: o TCAs (tricyclic antidepressants) o Second generation antipsychotics Thorazine is a first-generation antipsychotic and is not indicated in the treatment of OCD. Ativan is a benzodiazepine and is FDA-approved for generalized anxiety disorder. Although OCD is in the family of anxiety disorders, Ativan is not a first-line treatment for OCD. It is used for anxiety disorders and is not FDA-approved for the treatment of OCD. Promethazine is an antihistamine and not indicated in the treatment of OCD. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 221.

As a nurse practitioner, you are responsible for assessing cranial nerves as part of the neurological exam. What cranial nerve assessment tests the patient's gag reflex? 1. A Vagus nerve (CN X) 2. B Abducens nerve (CN VI) 3. C Hypoglossal nerve (CN XII) 4. D Glossopharyngeal nerve (CN IX)

Hide Explanation Correct answer: Glossopharyngeal nerve (CN IX) Olfactory nerve (CN I) The olfactory nerve transmits information to the brain regarding a person's sense of smell. This cranial nerve assessment is performed by having the client close their eyes to identify familiar odors. Optic nerve (CN II) The optic nerve transmits information to the brain regarding a person's vision. Oculomotor nerve (CN III) The oculomotor nerve helps control muscle movements of the eyes. The oculomotor nerve provides movement to most of the muscles that move the eyeball and upper eyelid, known as extraocular muscles. The oculomotor nerve also helps with involuntary functions of the eye. Trochlear nerve (CN IV) The trochlear nerve is also involved in eye movement. The trochlear nerve, like the oculomotor nerve, originates in the midbrain. It powers the contralateral superior oblique muscle that allows the eye to point downward and inward. Trigeminal nerve (CN V) The trigeminal nerve is the largest cranial nerve and has both motor and sensory functions. Its motor functions help a person to chew and clench the teeth and gives sensation to muscles in the tympanic membrane of the ear. This test is performed by touching the face and corneal reflex of the eye with a wisp of cotton and pin-pricking the skin and mucosa to test touch. Abducens nerve (CN VI) The abducens nerve also helps control eye movements. It helps the lateral rectus muscle, which is one of the extraocular muscles, to turn the gaze outward. Facial nerve (CN VII) The facial nerve functions to produce facial expressions and has both motor and sensory functions. Vestibulocochlear nerve (CN VIII) The vestibulocochlear nerve is involved with a person's hearing and balance. It is assessed by checking the client's hearing using an audiometer or by simply whispering in the client's ear. Hearing loss is tested with the Weber and Rinne tests. Glossopharyngeal nerve (CN IX) The glossopharyngeal nerve possesses both motor and sensory functions. It is involved with the sensation of taste for the back of the tongue. Vagus nerve (CN X) The vagus nerve has a range of functions, providing motor, sensory, and parasympathetic functions. It plays a role in taste sensation, provides movement to the throat and soft palate, and regulates heart rhythm. Accessory nerve (CN XI) HeThe accessory nerve provides motor function to the neck. It controls muscles that allow a person to rotate, extend, and flex the neck and shoulders. The cranial part of the accessory nerve combines with the vagus nerve. Hypoglossal nerve (CN XII) The hypoglossal nerve is a motor nerve that supplies the tongue muscles. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 80-81.

Bipolar disorder is believed to be related to an increase in what neurotransmitter? 1. A GABA 2. B Glutamate 3. C Dopamine 4. D Norepinephrine

Hide Explanation Correct answer: Glutamate Bipolar disorder is believed to be related to an increase in glutamate. Glutamate is an excitatory amino acid neurotransmitter. While the exact connection between glutamate and bipolar disorder remains unclear, proton magnetic resonance spectroscopy studies have found increased glutamate in those with bipolar disorder compared with healthy controls. Glutamate is also implicated in seizure disorders and schizophrenia. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 69.

In common psychiatric disorders, neurotransmitters are implicated in the complex pathophysiology of certain disease processes. It is important to understand neurotransmitters in the central nervous system in order to better diagnose and treat common psychiatric illnesses. Which neurotransmitter's general function involves memory and sustained autonomic functions? 1. A Glutamate 2. B Dopamine 3. C Norepinephrine 4. D Serotonin

Hide Explanation Correct answer: Glutamate The general function of glutamate involves memory and sustained autonomic functions. The general function of dopamine involves normal functioning of thinking, decision-making, reward-seeking behavior, fine muscle action, and integrated cognition. The general function of norepinephrine involves alertness, orientation, fight-or-flight, learning, memory, and focus and attention. The general function of serotonin involves regulation of sleep, pain perception, mood states, temperature, aggression, and libido. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 71-72.

Your patient with bipolar disorder recently suffered a myocardial infarction (MI). He was stabilized at the hospital and discharged on propranolol (Inderal, Hemangeol, InnoPran), losartan (Cozaar), and hydrochlorothiazide (Microzide). Prior to his MI, his lithium level was consistently around 0.8 mmol/L on 900 mg of lithium carbonate per day. He arrives at your office today, and his lithium level is now 1.3 mmol/L on the same dose. What caused this change? 1. A Decreased volume distribution post-MI 2. B Losartan 3. C Propranolol 4. D Hydrochlorothiazide

Hide Explanation Correct answer: Hydrochlorothiazide Thiazide diuretics like hydrochlorothiazide (Microzide) decrease lithium clearance, thus increasing the amount of lithium in the body. Other medications that may increase lithium levels include the following: o Spironolactone (Aldactone) o Ethacrynic acid (Edecrin) o Triamterene (Dyrenium) o Metronidazole (Metrogel, Flagyl) o Tetracycline o Angiotensin-converting enzyme (ACE) inhibitors Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 988.

Increased levels of sodium (Na) can cause which of the following? 1. A GI fluid loss from vomiting and diarrhea 2. B Addison's disease 3. C Hypovolemia 4. D Renal disorders

Hide Explanation Correct answer: Hypovolemia Decreased, not increased, levels of sodium (Na) can cause Addison's disease, renal disorders, and gastrointestinal fluid loss from vomiting and diarrhea. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 91.

Which of the following is considered an environmental risk factor? 1. A Medication management 2. B Infection 3. C Exercise regimen 4. D Vaccination

Hide Explanation Correct answer: Infection Environmental risk factors include prenatal insults, stress, infections, poor nutrition, exposure to toxins, and physical or sexual abuse. Vaccinations are not considered environmental risk factors, as they are meant to provide supportive prevention of a disease process. Medication management is not considered an environmental risk factor, as they are meant to provide supportive treatment of illnesses and diseases. Exercise regimens are not considered environmental risk factors, because exercise improves health. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 75.

The two phases of the action potential are depolarization and repolarization. Depolarization is characterized by: 1. A Influx of sodium and calcium ions 2. B The restoration phase 3. C Potassium leaving the cell or chloride entering the cell 4. D An inhibitory response

Hide Explanation Correct answer: Influx of sodium and calcium ions The two phases of the action potential are depolarization and repolarization. Depolarization is characterized by: o The initial phase of the action potential; o An excitatory response; and o An influx of sodium and calcium ions into the cell. Repolarization is characterized by: o The restoration phase; o An inhibitory response; and o Potassium leaving the cell or chloride entering the cell. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 68.

The reticular formation regulates which body functions? 1. A Taste, reading, and writing 2. B Involuntary movement, muscle tone, blood pressure, and respiratory rate 3. C Mood, fear, emotions, and aggression 4. D Appetite, water balance, body temperature, and libido

Hide Explanation Correct answer: Involuntary movement, muscle tone, blood pressure, and respiratory rate The reticular formation is the part of the brain stem that regulates involuntary movement, muscle tone, blood pressure, and respiratory rate. The parietal lobe is the primary sensory area and is responsible for regulating taste, reading, and writing. The limbic system's amygdala regulates mood, fear, emotion, and aggression. The limbic system's hypothalamus regulates appetite, water balance, body temperature, and libido. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 67-68.

Each of the following is a true statement regarding the peripheral nervous system except: 1. A It includes the cranial nerves just outside the brain stem 2. B It is composed of the brain and the spinal cord 3. C It includes the somatic and autonomic nervous systems 4. D It connects the central nervous system to receptors, muscles, and glands

Hide Explanation Correct answer: It is composed of the brain and the spinal cord The central nervous system is composed of the spinal cord and the brain, not the peripheral nervous system. The peripheral nervous system is composed of the peripheral nerves that connect the central nervous system to receptors, muscles, and glands. It also includes the cranial nerves just outside the brainstem and includes both the somatic and autonomic nervous systems. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 64.

All of the following statements are true about gray matter except: 1. A It is composed of nerve cell bodies and dendrites 2. B It is found in the working area of the brain 3. C It contains the synapses 4. D It is the myelinated axons of neurons

Hide Explanation Correct answer: It is the myelinated axons of neurons Brain tissue is categorized as either white matter or gray matter. White matter is the myelinated axons of neurons. Gray matter is composed of nerve cell bodies and dendrites. Gray matter is found in the working area of the brain and contains the synapses. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 64.

You are a nurse practitioner treating a seven-year-old male child. His mother brings him in for his initial appointment with a chief complaint of "My son's teacher is concerned about my son because he is not able to finish his in-class schoolwork. I just don't know what to do." The mother states that it has been reported that her son fails to give attention in class, gets distracted often, is disorganized with his assignments, constantly loses his homework, is always talking out of turn and distracting other students, and interrupts when other students answer a question. After performing the necessary assessments and testing, you diagnose this client with attention deficit hyperactivity disorder (ADHD), inattentive type. You decide to start him on a low-dose non-stimulant. Which of the following is a non-stimulant that is FDA approved for the treatment of ADHD in children? 1. A Wellbutrin XL (bupropion) 2. B Kapvay (clonidine) 3. C Dexedrine (dextroamphetamine) 4. D Adderall (amphetamine salts)

Hide Explanation Correct answer: Kapvay (clonidine) The FDA has approved both stimulants and non-stimulants for the treatment of ADHD in children. The following medications are FDA approved but are not classified as stimulants: o Strattera (atomoxetine) o Intuniv (guanfacine) o Kapvay (clonidine) The following are stimulants: o Adderall (amphetamine salts) o Dexedrine (dextroamphetamine) Wellbutrin XL (bupropion) is an SNRI but is indicated in the treatment of ADHD in adults. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 338.

Decreased levels of potassium are seen in which of the following conditions? 1. A Insulin deficiency 2. B Laxative abuse 3. C Dehydration 4. D Acute renal failure

Hide Explanation Correct answer: Laxative abuse Decreased levels of potassium are seen in laxative abuse. They are also seen in the following: o Alkalosis o Excessive insulin o Burns o Trauma o Surgery o Cushing's syndrome o Hyperaldosteronism o Thyrotoxicosis o Anorexia nervosa o Diet deficient in meat and vegetables Increased levels of potassium are seen in the following: o Acidosis o Insulin deficiency o Addison's disease o Acute renal failure o Hypoaldosteronism o Infection o Dehydration Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 272.

Your patient with bipolar disorder is admitted to a medical hospital. The internist contacts your office and asks whether the lithium you prescribed him is affecting his electrocardiogram (ECG). How do you respond? 1. A Lithium can shorten the PR interval 2. B Lithium can invert the T-waves 3. C Lithium has no effect on his ECG 4. D Lithium can prolong the QT interval

Hide Explanation Correct answer: Lithium can invert the T waves Lithium carbonate can cause T-wave flattening or inversion on an ECG; however, these changes are rarely clinically significant. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 987.

Which psychiatric medication possesses a low therapeutic index, and thus a low margin of safety? 1. A Lithium carbonate 2. B Bupropion 3. C Divalproex 4. D Alprazolam

Hide Explanation Correct answer: Lithium carbonate A medication's therapeutic index refers to the relative measure of its toxicity or safety. Specifically, it is the ratio of the median toxic dose to the median effective dose. o Drugs with a low therapeutic index, such as lithium carbonate, have a low margin of safety. This means that the therapeutic dose and the toxic dose are close together. o Drugs with a high therapeutic index such as Divalproex have a high margin of safety. This means that the therapeutic dose and the toxic dose are far apart. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 114.

All of the following are examples of nursing-sensitive adverse events except: 1. A Medication errors 2. B Failure to rescue 3. C Low nurse-to-patient ratio 4. D Nosocomial infections

Hide Explanation Correct answer: Low nurse-to-patient ratio Low nurse-to-patient ratio is not an example of a nursing-sensitive adverse event (NSAE). Examples of NSAEs include: o Failure to rescue o Nosocomial infections o Pressure ulcers o Falls o Medication errors o Transfusion errors Reference: Zaccagnini, M. E., & White, K. W. (2017). The doctor of nursing practice essentials: A new model for advanced practice nursing. Burlington: Jones & Bartlett Learning. Pg 169-172.

A known patient of yours with a diagnosis of PTSD presents to your clinic for a refill of his medication. Today, he complains of nightmares. What medication will you choose as adjunctive therapy? 1. A Risperdal (risperidone) 2. B Minipress (prazosin) 3. C Ativan (lorazepam) 4. D Wellbutrin (bupropion)

Hide Explanation Correct answer: Minipress (prazosin) Minipress (prazosin) is FDA-approved for the treatment of nightmares associated with PTSD. Ativan (lorazepam) is not recommended as a treatment for PTSD. Wellbutrin (bupropion) is an SNRI and not used as treatment for PTSD. Risperdal (risperidone) is a second-generation antipsychotic and is not used in the treatment of nightmares associated with PTSD. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 224-225.

All of the following statements about psychotropic medications are true except: 1. A Because most psychotropics are highly protein-bound, people with low albumin levels are at an increased risk of drug toxicity 2. B Most psychotropics are hepatic cytochrome P450 enzyme inducers 3. C Older adults have more body fat, putting them at increased risk for erratic blood levels of psychotropic medication 4. D It takes approximately five half-lives to completely eliminate most psychotropics from the body

Hide Explanation Correct answer: Most psychotropics are hepatic cytochrome P450 enzyme inducers Most psychotropic medications are hepatic cytochrome P450 inhibitors. Furthermore, most psychotropic medications are both lipophilic and highly protein-bound. Because many older adults have more body fat and less protein, they are at increased risk for toxicity. It takes approximately five half-lives to completely eliminate most psychotropics from the body. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 112-113.

A 29-year-old African American female was diagnosed with schizophrenia approximately three years ago. After many trials of antipsychotics, she was finally stabilized on haloperidol during the past six months. Three weeks ago she began exhibiting mild pseudo-Parkinson's symptoms. Which class of medications would be most appropriate for treating these side effects? 1. A Muscarinic 1 antagonist 2. B Histamine 1 antagonist 3. C Alpha 1 adrenergic agonist 4. D Cholinesterase inhibitor

Hide Explanation Correct answer: Muscarinic 1 antagonist Extrapyramidal symptoms are drug-induced side effects that affect motor functioning and muscle movement. Extrapyramidal symptoms are associated with a deficiency of dopamine and an excess of acetylcholine in the nigrostriatal pathway. A common type of extrapyramidal symptom is called pseudo-Parkinson's, which presents with a shuffling gait, motor slowing, mask-like facial expression, tremors, and muscle rigidity. Muscarinic 1 antagonist medications reduce the effects of excess acetylcholine and relieve extrapyramidal symptoms. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-Mental Health Nurse Practitioner Review Manual, Fourth Edition. Pg 251-252.

What is the basic cellular unit of the nervous system? 1. A Axon 2. B Neuron 3. C White matter 4. D Dendrite

Hide Explanation Correct answer: Neuron The neuron is the basic cellular unit of the nervous system. It has been called the "microprocessor" of the brain responsible for conducting impulses from one part of the body to another. Dendrites collect incoming signals from other neurons and send the signals toward the neuron's cell body. The axon transmits signals away from the neuron's cell body to connect with other cells. White matter is a type of brain tissue that contains myelinated axons of neurons. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 63-64.

All of the following statements about neurotransmitters are true except: 1. A Examples of neurotransmitters include monoamines, amino acids, cholinergics, and peptides 2. B Neurotransmitters are chemicals synthesized from dietary substrates 3. C Neurotransmitters communicate information from one cell to another 4. D Neurotransmitters convert an action potential into a chemical signal All of the following statements about neurotransmitters are true except: 1. A Examples of neurotransmitters include monoamines, amino acids, cholinergics, and peptides 2. B Neurotransmitters are chemicals synthesized from dietary substrates 3. C Neurotransmitters communicate information from one cell to another 4. D Neurotransmitters convert an action potential into a chemical signal

Hide Explanation Correct answer: Neurotransmitters convert an action potential into a chemical signal The synapse, not the neurotransmitter, converts the action potential in the presynaptic neuron into a chemical signal that is then transferred to the postsynaptic neuron. Neurotransmitters are chemicals synthesized from dietary substrates that communicate information from one cell to another. They can be divided into four categories: monoamines, amino acids, cholinergics, and peptides. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 68-70.

In common psychiatric disorders, neurotransmitters are implicated in the complex pathophysiology of certain disease processes. It is important to understand neurotransmitters in the central nervous system in order to better diagnose and treat common psychiatric illnesses. Which neurotransmitter's general function involves alertness, orientation, fight-or-flight, learning, memory, and focus and attention? 1. A Glutamate 2. B Norepinephrine 3. C Serotonin 4. D Dopamine

Hide Explanation Correct answer: Norepinephrine The general function of norepinephrine involves alertness, orientation, fight-or-flight, learning, memory, and focus and attention. The general function of serotonin involves regulation of sleep, pain perception, mood states, temperature, aggression, and libido. The general function of glutamate involves memory and sustained autonomic functions. The general function of dopamine involves normal functioning of thinking, decision-making, reward-seeking behavior, fine muscle action, and integrated cognition. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 71-72.

Which neurotransmitter is matched correctly with its general function? 1. A Norepinephrine: alertness, focused attention, learning, and memory 2. B GABA: thinking, fine muscle action, and reward-seeking behavior 3. C Dopamine: sleep, pain, mood states, and temperature 4. D Serotonin: reduces arousal, aggression, and anxiety

Hide Explanation Correct answer: Norepinephrine: alertness, focused attention, learning, and memory The neurotransmitters are matched with their correct functions below. o Norepinephrine: alertness, focused attention, learning, and memory o Dopamine: thinking, fine muscle action, and reward-seeking behavior o GABA: reduces arousal, aggression, and anxiety o Serotonin: regulates sleep, pain, mood states, and temperature Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 71.

Why are older adults more sensitive to psychotropic medication? 1. A Psychotropic medications are lipophobic and highly protein-bound 2. B Older adults have a higher rate of first-pass metabolism 3. C Older adults have low muscle mass and increased body fat concentration 4. D The time needed to clear 50% of the drug decreases in an older adult

Hide Explanation Correct answer: Older adults have low muscle mass and increased body fat concentration Psychotropic medications are lipophilic and highly protein-bound. Older adults are more sensitive to psychotropic medications due to their o Decreased intracellular water o Low muscle mass o Decreased protein binding o Increased body fat concentration o Decreased rate of metabolism Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 113.

As a nurse practitioner, you are responsible for assessing cranial nerves as a part of the neurological exam. What cranial nerve assessment tests smell, ensures patency of the nasal passages, and is performed by having the client close their eyes to identify familiar odors? 1. A Facial nerve (CN VII) 2. B Trigeminal nerve (CN V) 3. C Hypoglossal nerve (CN XII) 4. D Olfactory nerve (CN I)

Hide Explanation Correct answer: Olfactory nerve (CN I) Olfactory nerve (CN I) The olfactory nerve transmits information to the brain regarding a person's sense of smell. This cranial nerve assessment is performed by having the client close their eyes to identify familiar odors. Optic nerve (CN II) The optic nerve transmits information to the brain regarding a person's vision. Oculomotor nerve (CN III) The oculomotor nerve helps control muscle movements of the eyes. The oculomotor nerve provides movement to most of the muscles that move the eyeball and upper eyelid, known as extraocular muscles. The oculomotor nerve also helps with involuntary functions of the eye. Trochlear nerve (CN IV) The trochlear nerve is also involved in eye movement. The trochlear nerve, like the oculomotor nerve, originates in the midbrain. It powers the contralateral superior oblique muscle that allows the eye to point downward and inward. Trigeminal nerve (CN V) The trigeminal nerve is the largest cranial nerve and has both motor and sensory functions. Its motor functions help a person to chew and clench the teeth and gives sensation to muscles in the tympanic membrane of the ear. This test is performed by touching the face and corneal reflex of the eye with a wisp of cotton and pin-pricking the skin and mucosa to test touch. Abducens nerve (CN VI) The abducens nerve also helps control eye movements. It helps the lateral rectus muscle, which is one of the extraocular muscles, to turn the gaze outward. Facial nerve (CN VII) The facial nerve functions to produce facial expressions and has both motor and sensory functions. Vestibulocochlear nerve (CN VIII) The vestibulocochlear nerve is involved with a person's hearing and balance. It is assessed by checking the client's hearing using an audiometer or by simply whispering in the client's ear. Hearing loss is tested with the Weber and Rinne tests. Glossopharyngeal nerve (CN IX) The glossopharyngeal nerve possesses both motor and sensory functions. It is involved with the sensation of taste for the back of the tongue. Vagus nerve (CN X) The vagus nerve has a range of functions, providing motor, sensory, and parasympathetic functions. It plays a role in taste sensation, provides movement to the throat and soft palate, and regulates heart rhythm. Accessory nerve (CN XI) HeThe accessory nerve provides motor function to the neck. It controls muscles that allow a person to rotate, extend, and flex the neck and shoulders. The cranial part of the accessory nerve combines with the vagus nerve. Hypoglossal nerve (CN XII) The hypoglossal nerve is a motor nerve that supplies the tongue muscles. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 80-81.

Which medication functions by inhibiting serotonin reuptake pumps, thus increasing the availability of serotonin in the synaptic clef? 1. A Phenelzine 2. B Diazepam 3. C Paroxetine 4. D Bupropion

Hide Explanation Correct answer: Paroxetine The antidepressant class of medications called selective serotonin reuptake inhibitors (SSRIs) provide a therapeutic effect by inhibiting serotonin reuptake pumps and thus increasing the availability of serotonin in the synaptic clef. Examples of SSRIs: o Paroxetine o Sertraline o Fluoxetine o Escitalopram o Fluvoxamine Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI), phenelzine is a monoamine oxidase inhibitor (MAOI), and diazepam is a benzodiazepine. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 116.

Which of the following correctly pairs the pharmacodynamic effect with its definition? 1. A Inverse agonist effect: drug binds to receptors and activates a biological response 2. B Partial agonist effect: drug does not fully activate the receptors 3. C Antagonist effect: drug causes the opposite effect of agonist 4. D Agonist effect: drug binds to the receptor but does not activate a biological response

Hide Explanation Correct answer: Partial agonist effect: drug does not fully activate the receptors Psychiatric medications can cause four different pharmacodynamic effects on cell receptors. o Agonist effect: drug binds to receptors and activates a biological response o Inverse agonist effect: drug causes the opposite effect of agonist o Partial agonist effect: drug does not fully activate the receptors o Antagonist effect: drug binds to the receptor but does not activate a biological response Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 113.

A known patient of yours with a diagnosis of PTSD presents to your clinic for a refill of his medication. You meet with him and determine that he is stable and does not need any medication adjustments at this time. You provide him with a renewal prescription of what medication? 1. A Haldol (haloperidol) 2. B Paxil (paroxetine) 3. C Lithium 4. D Ativan (lorazepam)

Hide Explanation Correct answer: Paxil (paroxetine) Paxil is an SSRI and is FDA-approved for the treatment of PTSD. Another SSRI medication that is FDA-approved and often used in the treatment of PTSD is Zoloft (sertraline). Haldol is a first-generation antipsychotic and is not recommended in the treatment of PTSD. Lithium is a mood stabilizer and the gold standard for the treatment of bipolar I disorder; it is not FDA-approved for the treatment of PTSD. Ativan is not FDA-approved for and not recommended in the treatment of PTSD. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 224-225.

Problems with the frontal lobe could lead to which of the following? 1. A Visual field defects 2. B Sensory-perceptual disturbances 3. C Personality changes 4.D Aphasia and amnesia

Hide Explanation Correct answer: Personality changes Problems with the frontal lobe can lead to personality, emotional, and intellectual changes. Problems with the temporal lobe can lead to aphasia and amnesia. Problems with the occipital lobe can lead to visual field defects. Problems with the parietal lobe can lead to sensory-perceptual disturbances and agnosia. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 65.

Systemic effects of hyperkalemia include all of the following except: 1. A Polyuria 2. B Restlessness 3. C Intestinal cramping 4. D Tingling of lips and fingers

Hide Explanation Correct answer: Polyuria Polyuria is a sign of hypokalemia, not hyperkalemia. Effects of hyperkalemia: o Muscle weakness o Paralysis o Tingling of lips and fingers o Restlessness o Intestinal cramping o Diarrhea o Electrocardiogram changes Effects of hypokalemia: o Impaired carbohydrate metabolism o Impaired renal function o Polyuria o Polydipsia o Skeletal muscle weakness o Smooth muscle atony o Cardiac dysrhythmias o Paralysis and respiratory arrest Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 94.

You are a nurse practitioner treating a seven-year-old male. His mother brings him in for his initial appointment with a chief complaint of, "My son's teacher is concerned about my son because he is not able to finish his in-class schoolwork. I just don't know what to do." The mother states that it has been reported that her son fails to give attention in class, gets distracted often, is disorganized with his assignments, constantly loses his homework, is always talking out of turn and distracting other students, and interrupts when other students answer a question. Given this information, you decide to perform a mental status exam on the client. What findings would you expect when performing this assessment that would support a diagnosis of attention deficit hyperactivity disorder (ADHD)? 1. A Ability to recite serial 3s all the way up to 18 2. B Poor concentration and memory 3. C Childlike play activities 4. D Pays close attention to questions being asked

Hide Explanation Correct answer: Poor concentration and memory Mental status exam findings of ADHD include all of the following: o Restlessness o Inattention o Distractible speech patterns o Overproductive speech patterns o Affective lability o Poor memory o Poor concentration Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 337.

Which of the following is a biological factor influencing gender identity? 1. A Pre- and postnatal hormone levels 2. B Cultural attitudes toward sexual orientation 3. C Family and religious views on transsexuality 4. D Messages spread by the mass media related to sexual identity

Hide Explanation Correct answer: Pre- and postnatal hormone levels Gender identity is a person's sense of identity along a continuum between normative constructs of masculinity and femininity. Both biological and social factors influence gender identity. o Biological factors include pre- and postnatal hormone levels and gene expression. o Social factors include gender messages from a person's culture, family, and the mass media. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 23-28.

What is a rare but dangerous side effect of the antidepressant medication trazodone (Oleptro)? 1. A Anorgasmia 2. B Gynecomastia 3. C Impotence 4. D Priapism

Hide Explanation Correct answer: Priapism The incidence of priapism is about 1 in 6,000 men who are taking trazodone (Oleptro). Although rare, this side effect usually occurs within the first month of treatment and should prompt immediate discontinuation. Priapism is the prolonged erection of the penis, usually without sexual arousal. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 999.

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 side effect would you suspect? 1. A Akathisia 2. B Akinesia 3. C Dystonia 4. D Pseudo-Parkinson's

Hide Explanation Correct answer: Pseudo-Parkinson's Extrapyramidal symptoms are drug-induced side effects that affect motor functioning and muscle movement. Typical antipsychotics like haloperidol, perphenazine, and chlorpromazine are more likely to cause these side effects than atypical antipsychotics like olanzapine, lurasidone, and risperidone. The common types of extrapyramidal symptoms are listed below: o Akathisia: motor restlessness, inability to remain still, rocking, pacing, or constant motion of a unilateral limb, subjective sense of restlessness, often mistaken for increasing anxiety o Akinesia: absence of movement, difficulty initiating motion, subjective feeling of lack of motivation to move, often mistaken for laziness or lack of interest o Dystonia: muscle spasticity usually in the back or neck, subjectively painful, often mistaken for agitation o Pseudo-Parkinson's: shuffling gait, motor slowing, mask-like facial expression, pill-rolling, tremors, muscle rigidity o Tardive dyskinesia: involuntary abnormal muscle movement of the mouth, tongue, face, and jaw that may progress to limbs; can be irreversible, can occur as an acute process at the initiation of medications or as a chronic condition at any point during treatment Reference: Johnson, K., & Vanderhoef, D. Psychiatric-Mental Health Nurse Practitioner Review Manual, Fourth Edition. Pg 249.

The cerebral cortex is primarily responsible for which of the following? 1. A Converting short-term memory into long-term memory 2. B Stabilizing somatic motor activity 3. C Mediating mood, fear, emotion, and aggression 4. D Receiving incoming sensory information from the thalamus

Hide Explanation Correct answer: Receiving incoming sensory information from the thalamus The cerebral cortex is responsible for receiving incoming sensory information from the thalamus. The limbic system's amygdala mediates mood, fear, emotion, and aggression. The limbic system's hippocampus converts short-term memory into long-term memory. The basal ganglia stabilizes somatic motor activity. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 66.

Decreased levels of calcium can cause which of the following? 1. A Acidosis 2. B Renal failure 3. C Hyperthyroidism 4. D Addison's disease

Hide Explanation Correct answer: Renal failure Decreased levels of calcium can cause acute renal failure. Increased levels of calcium can cause acidosis, Addison's disease, and hyperthyroidism. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 89.

Decreased levels of calcium in the bloodstream is indicative of what type of disease process? 1. A Addison's disease 2. B Acidosis 3. C Hyperthyroidism 4. D Renal failure

Hide Explanation Correct answer: Renal failure In acute renal failure, calcium levels decrease. On the other hand, in disease processes such as acidosis, Addison's Disease, and hyperthyroidism, calcium levels are known to be increased. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 89.

Systemic effects of hypernatremia include which of the following? 1. A Restlessness 2. B Confusion 3. C Apprehension 4. D Lethargy

Hide Explanation Correct answer: Restlessness Systemic effects of hyponatremia include confusion, apprehension, and lethargy. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 91.

You are treating a 45-year-old patient who has been diagnosed with schizophrenia and treated with thioridazine (Mellaril) for the past 15 years. You decide to switch the patient to a different antipsychotic due to what serious long-term consequence of high-dose thioridazine? 1. A Priapism 2. B Retinal pigmentation 3. C Tardive dyskinesia 4. D Hyperprolactinemia

Hide Explanation Correct answer: Retinal pigmentation Retinal pigmentation can occur in patients prescribed >1,000 mg of thioridazine. Even when thioridazine is stopped, this side effect may persist and lead to blindness. Hyperprolactinemia, priapism, and tardive dyskinesia can occur as side effects of any antipsychotic medication. Reference: Sadock, Sadock & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 976.

A 29-year-old intellectually disabled female patient presents to the emergency room along with staff members from her residential care facility. Last week, her antipsychotic medication was switched from thioridazine to haloperidol. Upon examination, it is found that she is disorientated to time and place, is diaphoretic, and has a temperature of 105.3, a heart rate of 126 beats/minute, and a respiratory rate of 22 breaths/minute. Her extremities are stiff and rigid. Her labs reveal a white blood cell count of 14,000 and creatinine phosphokinase of 2,600 U/L. What is the most serious complication of her presenting syndrome? 1. A Myocardial infarction 2. B Respiratory failure 3. C Pulmonary embolism 4. D Rhabdomyolysis

Hide Explanation Correct answer: Rhabdomyolysis This patient presents with traditional indications of neuroleptic malignant syndrome (NMS). NMS is a life-threatening complication that can occur at any time during the course of antipsychotic treatment. Rhabdomyolysis (a breakdown of muscle tissue that releases a damaging protein into the blood) is the most common serious complication of NMS, and dialysis may be required to protect her from renal failure. High-potency antipsychotic medications, such as haloperidol, pose the greatest risk for NMS. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 925.

A patient presents to your clinic with reports of excessive hand washing and feeling as if she cannot leave the house unless she washes her hands seven times for five minutes each time. The patient further explains that she often shows up for work late because her anxiety keeps her from completing these tasks with enough time to get to work by her start time. You obtain further history and learn that the patient's mother had similar issues with cleaning the house. You give this patient a diagnosis of obsessive-compulsive disorder (OCD) and prescribe Prozac to help with her illness. Four weeks later, the patient returns to your clinic for a follow-up appointment. She reports that the anxiety is better and she is not performing these tasks as much but still finds herself needing to perform the handwashing at least two to three times a week. You talk to the patient about adjunct treatment and offer to prescribe a second medication to help her with the OCD. You educate the patient on antipsychotics, and she is agreeable to trying a second medication. What medication will you choose as adjunctive therapy with the Prozac? 1. A Risperidone (Risperdal) 2. B Clozapine (Clozaril) 3. C Fluphenazine (Prolixin) 4. D Chlorpromazine (Thorazine)

Hide Explanation Correct answer: Risperidone (Risperdal) Risperdal is a second-generation antipsychotic and is recommended as adjunctive therapy in the treatment of OCD. Thorazine and Prolixin are both first-generation antipsychotics and are not recommended as adjunctive therapy for OCD. Clozaril is a second-generation antipsychotic and not recommended as adjunctive therapy for OCD. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 221.

In common psychiatric disorders, neurotransmitters are implicated in the complex pathophysiology of certain disease processes. An increase in dopamine will cause an exacerbation of which disorder? 1. A Bipolar affective disorder 2. B Schizophrenia 3. C Anhedonia 4. D Parkinson's disease

Hide Explanation Correct answer: Schizophrenia In schizophrenia, the patient suffers from an increase in dopamine, which can result in psychotic symptoms and other symptoms associated with this illness. In Parkinson's disease there is a decrease in dopamine. When a patient is suffering from anhedonia, there is also a decrease in dopamine. In bipolar affective disorder there is an increase in glutamate. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 70.

In common psychiatric disorders, neurotransmitters are implicated in the complex pathophysiology of certain disease processes. It is important to understand neurotransmitters in the central nervous system in order to better diagnose and treat common psychiatric illnesses. Which neurotransmitter's general function involves regulation of sleep, pain perception, mood states, temperature, aggression, and libido? 1. A Dopamine 2. B Serotonin 3. C Glutamate 4. D Norepinephrine

Hide Explanation Correct answer: Serotonin The general function of serotonin involves regulation of sleep, pain perception, mood states, temperature, aggression, and libido. It is a precursor for melatonin. The general function of dopamine involves normal functioning of thinking, decision-making, reward-seeking behavior, fine muscle action, and integrated cognition. The general function of norepinephrine involves alertness, orientation, fight-or-flight, learning, memory, and focus and attention. The general function of glutamate involves memory and sustained autonomic functions. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 71-72.

A 31-year-old male diagnosed with depression undergoes an fMRI. His test reveals increased activity in the ventromedial prefrontal cortex. Which class of medication aids in pyramidal cell functioning in the prefrontal cortex by preventing the excessive release of glutamate? 1. A Norepinephrine and dopamine reuptake inhibitors (NDRIs) 2. B Serotonin-norepinephrine reuptake inhibitors (SNRIs) 3. C Serotonin antagonist/reuptake inhibitors 4. D Selective serotonin reuptake inhibitors (SSRIs)

Hide Explanation Correct answer: Serotonin antagonist/reuptake inhibitors Serotonin antagonist/reuptake inhibitors block 5HT2A receptors. This action inhibits glutamate release in the prefrontal cortex of the brain. Neither SSRIs, SNRIs, nor NDRIs block 5HT2A receptors. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-Mental Health Nurse Practitioner Review Manual, Fourth Edition. Pg 154-155.

Which medication might cause a false positive urine drug screen for benzodiazepines? 1. A NSAIDS 2. B Amoxicillin 3. C Codeine 4. D Sertraline

Hide Explanation Correct answer: Sertraline Some medications can possibly cause a false urinary drug screen result. If a patient is taking sertraline at the time of a drug screen, they may falsely test positive for benzodiazepines. If the patient is taking amoxicillin or NSAIDS, they may falsely test positive for cocaine. If a patient is taking codeine, they may falsely test positive for methadone or PCP. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 119.

A 21-year-old female presents to your office at the request of her parents. Her family is concerned because she has not been eating or sleeping and she has been talking nonstop for the past few weeks. The patient states that she has never felt better in her life, and she is painting ten new "masterpieces" every day. She believes she will be the next Van Gogh. She does not have any previous psychiatric history, and she denies the use of any substances. What initial laboratory data will you obtain before beginning treatment? 1. A Serum ammonia 2. B Complete blood count with differential 3. C Serum creatinine, BUN and electrolytes, thyroid studies, and urinalysis 4. D Prothrombin and partial thromboplastin times

Hide Explanation Correct answer: Serum creatinine, BUN and electrolytes, thyroid studies, and urinalysis This patient presents with manic symptoms, which should be treated with lithium carbonate. The minimum initial laboratory studies required before starting lithium include serum creatinine, BUN and electrolytes, thyroid studies, and urinalysis. Ninety-five percent of lithium is excreted through the kidneys; therefore, you should check the patient's kidney function by ordering electrolytes, creatinine, BUN, and a urinalysis. Lithium also inhibits the synthesis of thyroid hormone, so you should always check thyroid studies as well. Ordering a complete blood count is optional. Serum ammonia and prothrombin and partial thromboplastin times are unnecessary. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 983.

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? 1. A She was recently placed on a beta blocker for anxiety 2. B She recently began a new retroviral regimen for hepatitis 3. C She was recently prescribed a benzodiazepine by her primary care provider for panic attacks 4. D She recently had an acute flare-up of her rheumatoid arthritis and received treatment for one week for stabilization of symptoms

Hide Explanation Correct answer: She recently had an acute flare-up of her rheumatoid arthritis and received treatment for one week for stabilization of symptoms Patients with rheumatoid arthritis (RA) who experience an acute episode may be prescribed a short-term steroid to alleviate the exacerbation of RA. Steroids are known to cause mania in patients with bipolar disorder. Beta blockers, benzodiazepines, and retroviral agents cause an exacerbation of depressive symptoms, not mania. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 119.

Functions of the frontal lobe include all of the following except: 1. A Expressive speech 2. B Executive functioning 3. C Impulse control 4. D Simulating the activity of organs

Hide Explanation Correct answer: Simulating the activity of organs The frontal lobe is the largest, most developed lobe. Its functions include the following: o Controlling voluntary motor activity of specific muscles o Coordinating movement of multiple muscles o Allowing for multimodal sensory input to trigger memories o Executive functioning, which includes reasoning, impulse control, planning, prioritizing, intelligence, and abstraction o Expressive speech o Personality development Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 65.

Regarding assessment skills and advanced health and physical assessments, the role of the PMHNP-BC is supportive in nature and ensures the following: 1. A Specific focus and interventions are limited to conditions of a psychiatric nature while ruling out presentations possibly caused by non-psychiatric conditions. 2. B The PMHNP-BC is confident and competent to perform procedures such as breast exams and Pap smears. 3. C Neurological exams should be performed by a specialist in the area of neurology rather than psychiatry. 4. D The PMHNP-BC is often trusted more than primary care providers and is able to support the client with primary care needs.

Hide Explanation Correct answer: Specific focus and interventions are limited to conditions of a psychiatric nature while ruling out presentations possibly caused by non-psychiatric conditions. The PMHNP-BC specifically focuses on assessing for disorders or conditions that explain client presentation of psychiatric disorders and those that may mimic a psychiatric illness. Although the PMHNP-BC has been trained in advanced assessment skills, it is advised that intrusive exams be avoided. Although psychiatric patients are more prone not to visit primary care providers, the PMHNP-BC should always refer the client out for non-psychiatric treatment and always support the necessity of establishing care with a primary care provider. All PMHNP-BC providers should be competent in performing in-depth neurological exams. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 79-80.

Your 60-year-old patient with schizophrenia arrives in your office for a routine medication check. He has been treated with haloperidol (Haldol) and benztropine (Cogentin) for the past 25 years. About one and a half years ago, he developed some lip smacking and tongue protrusions that did not bother him. Today, however, he presents with odd, irregular arm movements. What syndrome most accurately describes these symptoms? 1. A Tardive dyskinesia 2. B Sydenham chorea 3. C Anticholinergic toxicity 4. D Meige syndrome

Hide Explanation Correct answer: Tardive dyskinesia This patient's presentation is most likely tardive dyskinesia, a movement disorder that can occur after long-term use of antipsychotic medication like haloperidol (Haldol). It is characterized by abnormal motor movements including lip smacking, facial grimacing, and choreoathetosis-like movements of the limbs and trunk. Anticholinergic toxicity would be accompanied by delirium. Meige syndrome is an oral facial dystonia that involves blinking and chin thrusting. Sydenham chorea is associated with rheumatic fever and occurs in children. Reference: Sadock, Sadock & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 1301.

You are working in an ER setting as a psychiatric-mental health nurse practitioner. You are asked to consult on a 45-year-old male patient who is in a psychiatric crisis. The ER physician states that he believes the patient is in a psychotic state due to methamphetamine abuse, as his urine drug screen was positive for methamphetamines. You speak with the patient's mother and learn that the patient has suffered from chronic schizophrenia since the age of 18 and had previously been stabilized on Abilify for his psychosis and another medication for his depression. The mother further endorses that her son refuses to take the Abilify because he does not "feel" schizophrenic any longer. He has, however, continued to take his antidepressant medication for depression. Given the history provided, you suspect that the patient is in a psychotic crisis due to discontinuance of the Abilify and not due to methamphetamine intoxication. What findings led you to suspect this and are supportive of your diagnosis? 1. A His mother indicates that her son takes Zoloft (sertraline) for depression 2. B His mother indicates that her son takes Motrin for pain 3. C His mother indicates that her son takes Prozac (fluoxetine) for depression 4. D His mother indicates that her son eats muffins with poppy seeds on them every morning for breakfast and throughout the day as a snack

Hide Explanation Correct answer: The mother indicates that her son takes Prozac (fluoxetine) for depression Prozac (fluoxetine) is an SSRI antidepressant and can produce a false positive for methamphetamine. The other options are incorrect for the following reasons: o Zoloft (sertraline) can produce a false positive for benzodiazepines o Motrin can produce a false positive for cocaine o Poppy seeds can produce a false positive for heroin or morphine Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 119.

You are working in an ER setting. You are asked to consult on a 45-year-old male patient who is in a psychiatric crisis. The ER physician states that he believes the patient is in a psychotic state due to methamphetamine abuse, as his urine drug screen was positive for methamphetamines. You are speaking with the mother of the patient and learn that the patient has suffered from chronic schizophrenia since the age of 18 and had previously been stabilized on Abilify for his psychosis and another medication for his depression. The mother further endorses that her son refuses to take the Abilify because he does not "feel" schizophrenic any longer. He has, however, continued to take his antidepressant medication for depression. Given the history provided, you suspect that the patient is in a psychotic crisis due to discontinuance of the Abilify and not methamphetamine intoxication. What findings led you to suspect this and are supportive of your diagnosis? 1. A The mother states that he takes Valium (diazepam) when he has a panic attack 2. B The mother states that he takes Wellbutrin (bupropion) for depression 3. C The mother states that he recently took Nyquil for the flu for one week 4. D The mother states that he takes Zoloft (sertraline) for depression

Hide Explanation Correct answer: The mother states that he takes Wellbutrin (bupropion) for depression Wellbutrin (bupropion) is an NDRI (norepinephrine and dopamine reuptake inhibitor) antidepressant and can produce a false positive for methamphetamine. The other answers are not correct for the following reasons: o Zoloft (sertraline) can produce a false positive for benzodiazepines o Nyquil can produce a false positive for methadone o Valium can produce a false positive for alcohol Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 119.

A patient presents with oculomotor disturbances, cerebellar ataxia, and mental confusion. What psychiatric emergency would you suspect? 1. A Cocaine intoxication 2. B Bereavement 3. C Wernicke's encephalopathy 4. D Alcohol intoxication

Hide Explanation Correct answer: Wernicke's encephalopathy Oculomotor disturbances, cerebellar ataxia, and mental confusion suggest a diagnosis of Wernicke's encephalopathy. The nurse practitioner should give thiamine 100 mg IV or IM and conduct a further evaluation. A patient experiencing bereavement might present with feelings of guilt, irritability, insomnia, and somatic complaints. Cocaine intoxication would present with paranoia, violence, severe anxiety, tachycardia, hypertension, and possibly myocardial infarction. Classic signs of alcohol intoxication include disinhibited behavior, slurred speech, discoordination, and sedation at high doses. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 781.

The definition of primary care is: 1. A The production of integrated, accessible health care tests by clinicians who are accountable for addressing all populations and their personal health care needs by developing a sustained partnership with patients, and practicing in the context of family and community with the financial backing of the insurance companies 2. B The provision of integrated, accessible health care services by clinicians who operate only under the umbrella of federal law, apply science to their practices, and seek to establish a practice devoted to only specialized areas of medicine 3. C The provision of integrated, accessible health care products by clinicians who are accountable for addressing minority populations and their personal health care needs by developing a sustained partnership with patients, and practicing in the context of family and community 4. D The provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community

Hide Explanation Correct answer: The provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community Reference: Buppert, Carolyn. Nurse Practitioner's Business Practice and Legal Guide, 5th Edition. Pg 7.

A 73-year-old Caucasian male with a diagnosis of Alzheimer's disease presents to your clinic. He currently smokes two packs of cigarettes per day and declines help with smoking cessation. Which medication for Alzheimer's disease is contraindicated due to his smoking habit? 1. A Galantamine 2. B There are no contraindications due to smoking for these medications 3. C Donepezil 4. D Rivastigmine

Hide Explanation Correct answer: There are no contraindications due to smoking for these medications You can choose any cholinesterase inhibitor to prescribe to this patient. There are no contraindications due to smoking for these medications. Galantamine might be the best choice for this patient because of its dual actions of (1) inhibiting acetylcholinesterase and (2) positive allosteric modulation of nicotinic cholinergic receptors. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 704-705.

The FDA recommends the following pharmacological management for anorexia nervosa: 1. A Prozac (fluoxetine) 2. B Effexor (venlafaxine) 3. C There is no specific medication therapy for anorexia nervosa 4. D Strattera (atomoxetine)

Hide Explanation Correct answer: There is no specific medication therapy for anorexia nervosa First-line treatment for anorexia nervosa is psychotherapy. Medication management is to be adjunct to psychotherapy. There is no recommendation by the FDA specifically with regard to medications to treat anorexia nervosa. SSRIs and TCAs have been shown to be effective in reducing the frequency of binge eating and purging disorders, but not anorexia nervosa. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 351.

Why is the outermost surface of the brain covered in sulci and fissures? 1. A They coordinate communication between the right and left hemispheres 2. B They increase the surface area of the brain 3. C They provide the most focal area for personality development 4. D They connect large bundles of white matter

Hide Explanation Correct answer: They increase the surface area of the brain The outermost surface of the brain contains small shallow dips (sulci) and deep grooves (fissures). These sulci and fissures increase the surface area of the brain to allow for more cell communication. The sulci and fissures also provide anatomical landmarks for reference points. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 64-65.

The measles, mumps and rubella vaccine should not be given to those in which of the following situations: 1. A Those who have received a blood transfusion in the past two weeks 2. B Children aged 6-12 3. C Postmenopausal women 4. D Men over the age of 25

Hide Explanation Correct answer: Those who have received a blood transfusion in the past two weeks Those who have received a blood transfusion in the past two weeks, pregnant women, people with cancer, those with weakened immune systems, and those who have HIV or AIDS with T-cell counts below 200 should not receive the MMR vaccine. MMR vaccines are safe for postmenopausal women, men over the age of 25, and children aged 6-12. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 98.

What is the primary purpose of the corpus callosum? 1. A To connect the right and left hemispheres and facilitate sensorimotor information exchange 2. B To coordinate movement of multiple muscles 3. C To control voluntary motor movement, working memory, and behavioral cueing 4. D To allow for multimodal sensory input and trigger memories

Hide Explanation Correct answer: To connect the right and left hemispheres and facilitate sensorimotor information exchange The corpus callosum is a large bundle of white matter that connects the right and left hemispheres and provides an area of sensorimotor information exchange. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 65.

The neuron is comprised of three parts: cell body, axon, and dendrite. What is the role of the axon? 1. A Transmits signals away from the neuron's cell body to connect with other neurons and cells 2. B Conveys information from the central nervous system to skeletal muscles 3. C Collects incoming signals from other neurons and sends the signals toward the neuron's cell body 4. D Maintains and restores energy by inhibiting the activity of organs

Hide Explanation Correct answer: Transmits signals away from the neuron's cell body to connect with other neurons and cells The neuron is comprised of three parts: cell body, axon, and dendrite. The axon transmits signals away from the neuron's cell body to connect with other neurons and cells. The dendrite collects incoming signals from other neurons and sends the signals toward the neuron's cell body. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 64.

As a nurse practitioner, you are responsible for assessing cranial nerves as a part of the neurological exam. What cranial nerve assessment tests for tactile perception of the facial skin? 1. A Facial nerve (CN VII) 2. B Trigeminal nerve (CN V) 3. C Hypoglossal nerve (CN XII) 4. D Olfactory nerve (CN I)

Hide Explanation Correct answer: Trigeminal nerve (CN V) Olfactory nerve (CN I) The olfactory nerve transmits information to the brain regarding a person's sense of smell. This cranial nerve assessment is performed by having the client close their eyes to identify familiar odors. Optic nerve (CN II) The optic nerve transmits information to the brain regarding a person's vision. Oculomotor nerve (CN III) The oculomotor nerve helps control muscle movements of the eyes. The oculomotor nerve provides movement to most of the muscles that move the eyeball and upper eyelid, known as extraocular muscles. The oculomotor nerve also helps with involuntary functions of the eye. Trochlear nerve (CN IV) The trochlear nerve is also involved in eye movement. The trochlear nerve, like the oculomotor nerve, originates in the midbrain. It powers the contralateral superior oblique muscle that allows the eye to point downward and inward. Trigeminal nerve (CN V) The trigeminal nerve is the largest cranial nerve and has both motor and sensory functions. Its motor functions help a person to chew and clench the teeth and gives sensation to muscles in the tympanic membrane of the ear. This test is performed by touching the face and corneal reflex of the eye with a wisp of cotton and pin-pricking the skin and mucosa to test touch. Abducens nerve (CN VI) The abducens nerve also helps control eye movements. It helps the lateral rectus muscle, which is one of the extraocular muscles, to turn the gaze outward. Facial nerve (CN VII) The facial nerve functions to produce facial expressions and has both motor and sensory functions. Vestibulocochlear nerve (CN VIII) The vestibulocochlear nerve is involved with a person's hearing and balance. It is assessed by checking the client's hearing using an audiometer or by simply whispering in the client's ear. Hearing loss is tested with the Weber and Rinne tests. Glossopharyngeal nerve (CN IX) The glossopharyngeal nerve possesses both motor and sensory functions. It is involved with the sensation of taste for the back of the tongue. Vagus nerve (CN X) The vagus nerve has a range of functions, providing motor, sensory, and parasympathetic functions. It plays a role in taste sensation, provides movement to the throat and soft palate, and regulates heart rhythm. Accessory nerve (CN XI) HeThe accessory nerve provides motor function to the neck. It controls muscles that allow a person to rotate, extend, and flex the neck and shoulders. The cranial part of the accessory nerve combines with the vagus nerve. Hypoglossal nerve (CN XII) The hypoglossal nerve is a motor nerve that supplies the tongue muscles. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 80-81.

Calcium values can be increased during treatment with lithium, thiazide diuretics, alkaline antacids, or vitamin D. 1. True 2. False

Hide Explanation Correct answer: True Calcium values can be increased during treatment with lithium, thiazide diuretics, alkaline antacids, or vitamin D. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 90

Functional imaging is a technique that measures functioning of areas of the brain and bases the resulting assessment on blood flow. In functional imaging, pharmaceuticals are used to cross the blood-brain barrier. 1. A False 2. B True

Hide Explanation Correct answer: True Functional imaging is a technique that measures functioning of areas of the brain and bases the resulting assessment on blood flow. In functional imaging, radioactive pharmaceuticals are used to cross the blood-brain barrier. Common functional imaging testing includes EEG and evoked potentials testing, magnetoencephalography (MEG), single photon emission computed tomography (SPECT), and positron emission tomography (PET). Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 72-73.

Genetic counseling is a communication process used when a client has a genetic risk, and it often involves offering a test that could provide information about the genetic status of the person and possible implications for the family. 1. A False 2. B True

Hide Explanation Correct answer: True Genetic counseling is a communication process used when a client has a genetic risk; it often involves offering a test that could provide information about the genetic status of the person and possible implications for the family. In psychiatry, genetic counseling can be an important tool in assisting the patient with medication management. For example, one type of genetic counseling and testing is called gene site testing, which allows both pharmacodynamic and pharmacokinetic medication matching. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner 4th edition. Pg 74.

Most disease processes are multifactorial. 1. A True 2. B False

Hide Explanation Correct answer: True Most disease processes are multifactorial, meaning they are caused by both environmental and genetic factors. Single-gene disorders are rare. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 75.

Calcium is a major cation for the structure of bones and teeth. 1. A False 2. B True

Hide Explanation Correct answer: True Not only is calcium a major cation for the structure of bones and teeth, it is also an enzymatic cofactor for blood clotting. It is required for hormone secretion, for the function of cell receptors, for plasma membrane stability and permeability, and for the transmission of nerve impulses and the contraction of muscles. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 89.

Psychotropic antipsychotics such as Seroquel and Risperdal can cause blurry vision and cataracts. 1. True 2. False

Hide Explanation Correct answer: True Psychotropic antipsychotics such as Seroquel and Risperdal can cause blurry vision and cataracts. Patients are advised to have routine eye exams every six months while being treated with antipsychotics. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 84.

Variable expression of a gene for a disorder occurs at the cellular level. 1. A False 2. B True

Hide Explanation Correct answer: True Variable expression of a gene for a disorder occurs at the cellular level. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 75.

Systemic effects of hypernatremia include all of the following except: 1. A Thirst 2. B Fever 3. C Hypotension 4. D Weight gain

Hide Explanation Correct answer: Weight gain Other presentations of hypernatremia: o Convulsions o Pulmonary edema o Dry mucous membranes o Tachycardia o Low jugular venous pressure o Restlessness Presentations of hyponatremia: o Lethargy o Headache o Confusion o Apprehension o Seizures o Coma o Hypotension o Tachycardia o Decreased urine output o Weight gain o Edema o Ascites o Jugular vein distension Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 91.

What is the difference between pharmacokinetics and pharmacodynamics? 1. A Pharmacokinetics is the study of what the body does to drugs, and pharmacodynamics is the study of what drugs do to the body 2. B Pharmacokinetics is the study of drug receptors and enzymes, and pharmacodynamics is the study of the mechanism of action of drugs 3. C Pharmacokinetics is the study of absorption, distribution, metabolism, and excretion; and pharmacodynamics is the study of what the body does to drugs 4. D Pharmacokinetics is the study of what drugs do and how they do it, and pharmacodynamics is the study of target sites for drug actions

Pharmacokinetics is the study of what the body does to drugs, and pharmacodynamics is the study of what drugs do to the body