Module Questions from FB Review
According to current clinical guidelines for treating a patient with bipolar I disorder mania with psychotic features, an adult psychiatric and mental health nurse practitioner prescribes: A. Lithium B. Citalopram (Celexa) C. Lamotrigine (Lamictal) D. Quetiapine (Seroquel)
D
An 81-year-old female with a history of vascular dementia is brought to the hospital for increased agitation and urinary tract infection (UTI). Which of the following features most distinguishes the effects of delirium from dementia? A. Altered level of consciousness B. Behavioral disturbances C. Cognitive deficits D. Disorientation
A
A 48-year-old Caucasian male patient presents for his therapy session. He is sad about losing his wife recently to COVID-19. He reports feeling thoughts of hurting himself. He has a past history of overdosing on propranolol several years ago. Which of the following places him at higher risk for suicide? a. Previous suicide attempt b. Age c. Gender d. Marital status
A
A 55-year-old patient with generalized anxiety disorder arrives at your clinic for her weekly therapy appointment. You have been counseling her for the past year. Today, she appears usually gloomy, and her eyes are bloodshot as if she had just been crying. She tells you that she is worried that she will never get better, and she will always feel this way. As the nurse practitioner, you understand that this patient has negative distorted beliefs about herself and her illness. What individual therapy method is most appropriate to use in helping this client through her current crisis? A. Cognitive-Therapy B. Eye movement desensitization and reprocessing (EMDR) C. Dialectical behavioral therapy (DBT) D. Existential therapy
A
A 65-year-old Caucasian male presents for an evaluation. The PMHNP has the patient complete the mini mental status examination (MMSE) and clock drawing. The patient is unable to correctly draw the face of the clock. Which area of the brain is likely to have compromised function? a. Cerebrum b. Cerebellum c. Wernicke's area d. Corpus Callosum
A
A 69-year-old man with diagnosis of delirium has symptoms of psychosis which include frightening auditory and visual hallucinations and paranoid delusions. Which of the following medications should be chosen first for this man's symptoms? a. Haloperidol b. Quetiapine c. Valium d. Olanzapine
A
A PMHNP recognizes that a number of his or her colleagues are prescribing a certain medication for an off-label use. The PMHNP's initial action is to: A. Conduct a literature search to determine if data supports the off-label use. B. Contact the pharmaceutical manufacturer to request related research findings. C. Prescribe the medication for off-label use. D. Report the colleagues to the state board of nursing.
A
A client who is experiencing difficulties with working memory, planning and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his or her knowledge that these symptoms represent problems with the a. Frontal lobe b. Temporal lobe c. Parietal lobe d. Occipital lobe
A
A community has an unusually high incidence of depression and drug use among the teenage population. The public health nurses decide to address the problem, in part, by modifying the environment and strengthening the capacities of families to prevent the development of new cases of depression and drug use. What is this an example of? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Protective factorial prevention
A
A patient with borderline personality disorder experiences intense anxiety when an adult psychiatric and mental health nurse goes on vacation. The best explanation for this reaction is that the patient: A. Has failed to develop clear ego boundaries B. Has failed to master object constancy C. Is employing primitive idealization D. Is employing projective identification
A
Dialectical behavioral therapy (DBT) draws on cognitive theory and behavioral theory, along with other theories. Elements of behavioral therapy in DBT include which of the following? A. Skills training and exposure B. Examination of feelings and relating feelings to visceral sensations C. Working through the transference with the therapist D. Cognitive interpretation of past traumatic experiences
A
Evidence Based Findings DOES NOT support use of which interventions to reduce symptoms in individuals with non-combat related PTSD: A. Anticonvulsants B. Eye movement, desensitization and reprocessing (EMDR) C. Exposure based cognitive behavior therapy D. SSRIs
A
In the annual exam of a 76-year-old man. Which of the following lab results are concerning? A. AST 85 & ALT 45 B. 5'6" & 140 lbs. C. BP 130/86, P 82, R 25 D. FBS 76, Hg 11.8, HCT 38%
A
Serotonin is a neurotransmitter that is implicated in sleep and mood. What area of the brain has a large majority of serotonin neurons? a. Raphe nuclei b. Nucleus Accumbens c. Locus Coeruleus d. Amygdala
A
The evidence hierarch ranks sources of knowledge according to the strength of information they provide. Which of the following would you find in Level I of an evidence hierarchy? A. Meta-analysis B. Cohort studies C. Opinions of expert committees D. Case control
A
The psychiatric-mental health nurse practitioner working in a crisis stabilization unit evaluates a patient verbalizing suicidal thoughts after being sexually assaulted. Before processing through the traumatic event, the nurse practitioner first attempts to: a. Provide an environment of safety b. Incorporate psychoeducation to address emotional dysregulation c. Promote cultivation of coping strategies to enhance distress tolerance Provide intense psychotherapy
A
The risk of bleeding on SSRI, non-steroidal anti-inflammatory drugs (NSAIDs), or aspirin, is an example of which of the following? A. Pharmacodynamic B. Absorption C. Distribution D. Pharmacokinetics
A
Which behavior reflects existentially oriented therapy? A. Attempting to understand a patient's subjective world B. Challenging a patient's irrational beliefs C. Developing specific plans for change D. Establishing general group goals
A
Which mood stabilizer is associated with potential life-threatening rash in the Asian population? a. Carbamazepine b. Depakote c. Lithium d. Lamictal
A
Which of the following medication has a unique mechanism that is both a norepinephrine and dopamine reuptake inhibitor? a. Bupropion (Wellbutrin) b. Sertraline (Zoloft) c. Clomipramine (Anafranil) d. Duloxetine (Cymbalta)
A
Which statement indicates that a patient is ready to terminate intensive psychiatric case management services? A. "I am no longer suicidal and group therapy is helping." B. "I am not the only person who has ever felt like this." C. "I just can't go outside. I get so anxious." D. "I miss our weekly sessions. I get so lonely."
A
Working with a 48-year-old patient recently diagnosed with schizophrenia and working using a recovery model: A. Focus on his feelings, interest, and dreams B. Assist finding a job C. Focus on side effects of medications D. Psychoeducation
A
An 18-year-old female diagnosed with a first-episode of Schizophrenia is amenable to take antipsychotic medication to lessen her hallucinations. She is opposed to taking meds that would cause her to gain weight. Which medication would be the most appropriate to prescribe? A. Clozapine (Clozaril) B. Olanzapine (Zyprexa) C. Quetiapine (Seroquel) D. Ziprasidone (Geodon)
D
An adult psychiatric and mental health nurse practitioner is using rational emotive therapy to treat a patient with depression and anxiety. An effective strategy for helping the patient recognize the connections between affect, cognition, and behavior is to: A. Focus on mindfulness techniques B. Provide an injunction to address assumptions C. Reinforce behaviors that have a sense of self-efficacy. D. Substitute the distorted thoughts with reality-oriented interpretations.
D
During a family session, a mother and father describe the discord they experience with their 14-year-old son and 11-year-old daughter, and the persistent anger and tension in the household. Which comment by the mother most indicates therapeutic progress? A. "We are getting along much better now that we are spending less time together." B. "We don't fight anymore." C. "We have decided to discuss positive events." D. "We seem able to discuss problems better."
D
During a follow-up assessment, a PMHNP ask patient to count backwards from 100 by sevens. What aspect of mental status exam is being assessed? a. Orientation b. Language c. Thought content d. Concentration
D
For 12 years, a 65-year-old patient with bipolar affective disorder has been treated with lithium (Eskalith) 900 mg daily. When oral hydrochlorothiazide (HCTZ) 12.5 mg daily is added for hypertension, the patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's serum lithium level is 2.0 mEq/L. The interaction of the lithium and the thiazide diuretic has induced: a. Hypokalemia b. Hyponatremia c. Increased renal clearance of lithium d. Reduced renal clearance of lithium
D
A married female patient has been in therapy with an adult psychiatric and mental health nurse practitioner for three months. The patient's husband abuses alcohol and refuses treatment. The night before the next scheduled appointment, the patient telephones the clinical nurse specialist stating that her husband is drunk, violent, and threatening to kill her. The PMHNP's priority intervention is to: a. Arrange for an emergency psychiatric evaluation b. Arrange for the woman's safety c. Request a restraining order d. Request to speak with the husband
B
A middle-school boy repeatedly lies, steals, bullies' peers, instigates fights, and inflicts harm without feeling any regret or remorse. These are characteristics of: A. Oppositional defiant disorder B. Conduct disorder C. Disruptive behavior disorder D. Antisocial personality disorder
B
For the past 18 months, an eight-year-old child has exhibited involuntary, purposeless, rapid recurrent movements of the arms and face as well as spontaneous unintelligible vocalizations. When receiving verbal cues, the child can decrease and sometimes extinguish the erratic movements for several minutes. The diagnosis is: A. Atypical tic disorder B. Chronic motor tic disorder C. Stereotypic movement disorder D. Tourette disorder
D
A mother brings in her 7-year-old son for a psychiatric follow-up visit with the PMHNP. This is the fourth visit the PMHNP has had with the client, his mother, and his younger sister, Renee, now 7 months old. You notice that she has a decrease in head growth, along with stereotypic motions of the hands, often licking and slapping. Renee has also lost her language skills. What medical condition do you suspect Renee has developed? A. Autism spectrum disorder B. Rett syndrome C. Selective mutism D. Childhood onset diabetes
B
A patient has been treated for the past several years with fluphenazine (Prolixin). You notice that he is drooling and has a tremor and slight pill-rolling movement of the fingers. These are the extrapyramidal symptoms known as: a. Anticholinergic effects b. Pseudo parkinsonism c. Tardive dyskinesia d. Dystonic reaction
B
A patient is diagnosed with schizophrenia. Which of the following would be the appropriate question for the PMHNP to ask when assessing side effects produced by dopamine antagonism in the nigrostriatal pathway? a. Are you experiencing nausea? b. Are you experiencing pill rolling tremors, shuffling gait, and masklike facial expression? c. Are you experiencing increased thirst? d. Are you experiencing breast discharge?
B
Any court of law that evaluates the standards of care provided by the PMHNP: A. Compares the actions to the standard of care provided by a psychiatrist. B. Considers what a reasonably prudent PMHNP would do in the same or similar circumstances. C. Evaluates patient satisfaction data. D. Reviews the nurse practitioner's charts for similar patients.
B
Sarah presents for her initial intake appointment with complaints of depression. She is being treated by hypertension and asthma by her primary care provider. Knowing that certain medications can cause or exacerbate depression; you obtain a complete medication history. Which of the following medications is known to exacerbate or cause depression? A. Omeprazole B. Propranolol C. Levothyroxine D. Clarithromycin
B
The PMHNP would expect to see which of the following during the physical exam for a patient with anorexia nervosa? a. Russell sign b. Low body mass index c. Erosion of dental enamel d. Hypertrophy of salivary glands
B
The parent or legal guardian of a 7-year-old child must approve any medication orders, because of child of this age fails to meet which two of the five elements of informed consent? A. Autonomy and veracity B. Competence and comprehension C. Confidentiality and beneficence D. Disclosure of informed and voluntariness
B
A new male patient has a 10-year history of substance abuse, depression, and anxiety. He is requesting Xanax. Which principle should the PMHNP employ moving forward? A. Beneficence B. Fidelity C. Non-maleficence (Do no harm; patient is at imminent risk due to substance use) D. Veracity
C
Which of the following structural changes is common in individuals with schizophrenia? A. Increased Glutamate and Decreased GABA release B. Increased Electrical activity in the frontal lobes C. Increased size of the cerebral ventricles D. Increased total brain volume
C
Which of these brain structures puts emotional meaning on a stimulus, forms emotional memories, and is involved with rage and fear? a. Hippocampus b. Temporal lobe c. Amygdala d. Midbrain
C
While providing a history, a patient requests a PMHNP disclose the information gathered with no one but the patient's spouse. By respecting this request, the NP demonstrates which component of the therapeutic relationship? A. Informed consent B. Beneficence C. Confidentiality D. Empathy
C
Your client Sam is being treated for panic disorder with agoraphobia. He currently is being prescribed paroxetine (Paxil CR, 37.5 mg q.d.) and clonazepam (Klonopin, 0.5 mg QD PRN). He has been on clonazepam for 2 years and admits to needing 4 pills to achieve the sme effect that 1 pill initially produced. This is possibly an example of which process? a. Kindling b. Addiction c. Tolerance d. Potency
C
A 22-year-old patient was diagnosed with major depressive disorder after 6 months of depression but did not respond to a trial of an SSRI or another trial of an SNRI. The most likely next step is to: A. Change to tricyclic antidepressant B. Explore the possible diagnosis of bipolar C. Try a different SSRI D. Consider electroconvulsive therapy
B
A 32-year-old male with a history of chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, hypertension, and new-onset severe physiologic tremor presents to the clinic with his wife. The wife is worried that the patient is misusing alcoholic beverages to self-treat his tremors. He has begun missing their children's school events and coming home late. He also has had more mood swings. Upon questioning the patient, he admits to increasing his overall alcohol intake. However, he does not acknowledge that he has a problem with alcohol and is in control. Vital signs are stable, and medications are appropriately reconciled and refilled. Which of the following is a questionnaire criterion available for use and at what stage of recovery does this patient stand? A. CAGE and he is in relapse B. CAGE and he is in pre-contemplation C. CAGE and he is in action D. CAGE and he is in contemplation
B
A 64-year-old Caucasian male referred for treatment of refractory depression be his PCP reports continued lack of purpose, insomnia, decreased energy, reduced interest in pleasurable activities since losing his wife hit by a drunk driver 3 months ago. Which of the following is an assessment priority? a. Prior and current meds, dose, clinical response, side effects b. Thoughts of self-harm, plan, intent, access c. Extent of alcohol use and motivation to reduce to safe levels d. Sleep patterns and hygiene
B
A PMHNP notices that few substance abuse treatment programs apply evidence-based practice. The PMHNP wants to initiate such a treatment program to: A. Implement the use of valid instruments. B. Improve outcomes through analysis and synthesis of evidence. C. Maximize interventions and increase skill utilization. D. Optimize revenue-generating potential.
B
A client says to the PMHNP, "Some days life is just not worth it. All my wife and I ever do is fight and scream. Things at home would be calmer and simpler if I just wasn't there anymore." The most therapeutic response for the PMHNP to make is a. "Do you mean that you are thinking about leaving your wife and moving out?" b. "Tell me what you mean by 'it would be simpler if you just weren't there anymore?'" c. "So you are thinking suicide might be an option for you?" d. Remain silent
B
A male patient informs an adult psychiatric and mental health nurse practitioner that he has not slept in three days, has poor concentration, and denies fatigue. The patient's diagnosis is: A. Attention-deficit hyperactivity disorder B. Bipolar disorder C. Panic disorder D. Primary insomnia
B
A married couple of 7 years presents for therapy because the wife perceives her husband to be a constant nag. He believes that he is correct and only trying to help. You assign him a paradoxical directive to schedule 1 hour per day in which he nags her, and once that hour is over to keep a list and save it until the next day. The PMHP recognizes this type of therapy as: A. Experiential therapy B. Strategic therapy C. Structural therapy D. Solution-focused therapy
B
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 EKG. How do you respond? A. Lithium can prolong the QT interval B. Lithium has no effect on his EKG C. Lithium can invert the T-waves D. Lithium can shorten the PR-interval
C
Tommy is an 8-year-old who presents to the PMHNP for evaluation of attention-deficit hyperactivity disorder. His mother completed the Vanderbilt ADHD rating scale and brought in the Vanderbilt teaching rating scale. Both your clinical interview and the rating scales indicate Tommy has ADHD. What assessment indicator(s) need to be completed prior to starting a stimulant medication? a. Get a copy of the rating scale completed by his grandparents. b. Assess for family history of cardiovascular disease and, if positive for conduction problems, order an electrocardiogram before prescribing medication. c. Obtain blood pressure, and pulse, and begin the stimulant medication. d. Assess for a family history of bipolar disorder
B
When working with a 26-year-old, Mike, who presents for treatment of cannabis use an d gambling, you use motivational interviewing techniques. As a PMHNP, you are familiar with the core counseling skills used in motivational interviewing. Mike made the following statement: "I don't know why I came here in the first place, but I thought maybe some medication would help me." You respond by saying, "You're feeling confused about the process" and Mike replies, "I never thought I'd need to come to a place like this." You respond, "You kept your appointment today and I appreciate the courage it took for you to come here." What two motivational interviewing techniques are used in this interaction? A. Interrupting and reassurance B. Affirming and reflecting C. Open-ended questions and summarizing D. Clarification and data collection
B
Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated with clozapine? a. 2D6 b. 1A2 c. 2C19 d. 2C9
B
Which of the following antidepressants is associated with the most cardiovascular adverse effects? a. Sertraline b. Citalopram c. Bupropion d. Duloxetine
B
Which serotonin receptor antagonism makes an antipsychotic "atypical"? a. 5HT4A b. 5HT2A c. 5HT1A d. 5HT3A
B
You are treating a client with Schizophrenia who takes clozapine. What laboratory values will indicate the client needs to discontinue treatment? a. White blood cell count of less than 1,800/mm3 and absolute neutrophil count of less than 1,200/mm3 b. Absolute neutrophil count of less than 1,000/uL c. White blood cell count of less than 1,200/mm3 d. Absolute neutrophil count of less than 2,000/uL
B
A 23-year-old woman is brought into the ER after attempting suicide by cutting her wrists. Which nursing action by the PMHNP would be of highest priority initially? A. Assess her coping behaviors B. Assess her current level of suicidality C. Take her vital signs (Make sure that she is stable first, ABC-circulation; make sure she is not bleeding and stable) Assess her health history
C
A 72-year-old female is brought in by her husband with increasing forgetfulness, decreased activity, and decreased appetite for 2 months. She has a history of hypertension and is being treated with lisinopril. The exam is normal, and the mini-mental status exam provides a score of 24 but she declines to answer some questions and needs to be urged to participate in the assessment. What is the most likely diagnosis? A. Alzheimer disease B. Vascular dementia C. Pseudodementia D. Medication toxicity
C
A PMHNP and a staff nurse are discussing the amount of time required to perform safety rounds on a psych inpatient unit. An initial evidence-based approach for investigating this topic is to: A. Conduct a time study B. Identify community standards C. Perform a literature search (ONLY EVIDENCE-BASED ANSWER OPTION) D. Survey the nursing staff
C
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? A. She was recently placed on a beta blocker for anxiety B. She was recently prescribed a benzodiazepine by her primary care provider for panic attacks C. She recently had an acute flare-up of her rheumatoid arthritis and received treatment for one week for stabilization of symptoms D. She recently began a new retroviral regimen for hepatitis
C
A week after raising the dose of clomipramine a patient treated for depression presents to the clinic with reports of acute change in mental status, fever, and hyperreflexia. As the treating PMHNP, you know these symptoms are consistent with which of the following? a. Extra Pyramidal Side Effect b. Neuroleptic Malignant Syndrome c. Serotonin syndrome d. Anticholinergic withdrawal syndrome
C
According to the Diagnostic and Statistical Manual of Mental Disorders, to diagnose attention deficit hyperactivity disorder, a PMHNP assesses a child's: A. Ability to listen when directly addressed B. Ability to remain seated in a classroom C. Behavioral functioning, both at home and at school
C
Appraisal of patient's SI, plan, method, intent, and access to implement plan would be documented in which part of standard psychiatric evaluation? a. Review of Systems b. Diagnosis c. Mental Status Exam d. History of Presenting Illness
C
During patient education about sertraline (Zoloft), an adult psychiatric and mental health nurse practitioner focuses upon the potential side effects of: A. Agranulocytosis B. Hypernatremia C. Sexual dysfunction D. Weight loss
C
Established clinical guidelines suggest that suicidality is decreased by treating patients who have borderline personality disorder with: A. Eye movement desensitization reprocessing B. Cognitive-behavioral therapy C. Dialectical behavioral therapy D. Interpersonal therapy
C
If given during pregnancy, sodium valproate can cause which of the following medical problems in the baby? a. Stevens-Johnson syndrome b. Epstein's anomaly c. Spina bifida d. Cleft palate
C
Impulsivity and suicidality are often associated are often associated with borderline personality disorder. Which of the following pharmacological intervention is frequently used to reduce impulsivity and suicidality? A. Tricyclic antidepressants B. Benzodiazepines C. Selective serotonin reuptake inhibitors D. Monoamine oxidase inhibitors
C
In forming a therapeutic relationship with clients, the PMHNP must consider developing many characteristics that are known to be helpful in relationship-building. Which of the following is an essential part of building a therapeutic relationship? a. Collecting a family history b. Like-mindedness c. Authenticity d. Accuracy in assessment
C
Laboratory findings for a patient with an alcohol use disorder indicate increased liver function values and: A. A decreased mean corpuscular volume (MCV) and normal triglyceride levels. B. Elevated potassium and chloride levels C. Increased MCV and elevated triglyceride levels D. Increased urine and serum creatine levels
C
Mary a 45-year-old African American female who has been treated on Isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical procedure. Which medication is strictly contraindicated with Isocarboxazid? A. Morphine B. NSAIDs C. Methylphenidate D. Acetaminophen
C
Mr. Smith, an involuntarily hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered meds because he believes Jesus Christ told him he is a prophet and must fast for a year. Your actions should be based on your knowledge that: A. Psych patients cannot refuse treatment B. Patients do not always know what is good for them C. Patients can refuse treatment D. Patients cannot be trusted to make good decisions and therefore, the nurse's best clinical judgement should guide actions
C
The neurochemical pathophysiology of Tourette disorder involves: A. Decreased levels of gamma-aminobutyric acid (GABA) and increased levels of glutamate in the brain. B. Deficits in the prefrontal cortex-mediated executive functions of the brain. C. Imbalances in dopaminergic, serotonergic, and noradrenergic systems in multiple regions of the brain. D. Overstimulation of noradrenergic activity located in the locus coeruleus of the brain.
C
The neuroprotective treatment of choice for bipolar disorder is: A. Carbamazepine (Tegretol) B. Divalproex sodium (Depakote) C. Lithium (Eskalith) D. Risperidone (Risperdal)
C
What muscle relaxant is recommended to be used in the treatment of neuroleptic malignant syndrome (NMS)? A. Bromocriptine B. Trihexyphenidyl C. Dantrolene D. Benztropine
C
What part of the brain is responsible for regulating emotions? a. Wernicke's area b. Occipital lobe c. Hippocampus d. Parietal lobe
C
When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons? a. Decreased body fat b. Increased liver capacity c. Decreased protein binding d. Increased muscle concentration
C
When working with a family in therapy, you plan to address differentiation of self triangles, and genomes. What family therapy approval will you be utilizing? A. Emotional focused family therapy B. Strategic family therapy C. Systemic family therapy D. Structural family therapy
C
When working with an avoidant patient with a history of trauma, what type of communication techniques are helpful? A. Techniques to decrease arousal B. Clarification and close-ended questions C. Techniques to increase arousal D. Reflection and open-ended questions.
C
Which characteristics of fluoxetine (Prozac) provides the greatest degree of safety for patients who have severe depression? A. Greater efficacy than tricyclic antidepressants B. Less potential for drug interactions C. Less potential for injury with intentional overdose D. Less potential for suicidal thinking
C
A 15-year-old boy is beating the owner of the convenience store he tried to rob. He has been in department of youth services custody several times for a variety of crimes against property, possession of illegal substances, and assault and battery. He is cheerful and unconcerned during the arrest, more worried about losing his leather jacket than about the fate of the man he has injured. Which of the following is the most likely diagnosis in this case? A. Oppositional defiant disorder B. Antisocial personality disorder C. Borderline personality disorder D. Conduct disorder
D
A 17-year-old patient arrives at the emergency department with nonspecific complaints. The patient's temperature is 100.8F (38.2C), pulse rate and blood pressure are elevated, and pupils are dilated with decreased reaction to light. Two days ago, the patient began taking sertraline (Zoloft) 50 mg daily for treatment of depression. The patient has a history of substance abuse and smoked marijuana one week ago. The diagnosis is: a. Alcohol withdrawal b. Infection affecting the central nervous system c. Neuroleptic malignant syndrome d. Serotonin syndrome
D
A 24-year-old female attempts suicide by overdose with the monoamine oxidase inhibitor phenelzine. She is stabilized at the hospital. Ten days later she is started on venlafaxine and becomes tachycardic and diaphoretic, and she develops myoclonic jerks. What condition is this? a. Neuroleptic malignant syndrome b. Opisthotonos c. Akathisia d. Serotonin syndrome
D
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? A. Akathisia B. Akinesia C. Dystonia D. Pseudo-Parkinson's
D
A 45-year-old male with a history of Schizophrenia is being seen today at the clinic. He is compliant with his antipsychotic meds and remains asymptomatic with auditory hallucinations and paranoia. On the mental status exam (MSE), he is noted to be coherent and articulate but makes no sense because many of the words he uses are of his own invention. Which term describes the patient's MSE sign? a. Clang associations b. Echolalia c. Flight of Ideas d. Neologisms
D
A 62-year-old female with history of schizophrenia is being discharged from inpatient admission to a psychiatric hospital and was referred for you to follow up in your private practice. During initial assessment, you ask her about her substance use history, and she talks about her late spouse, children, and grandkids. This is an example of a. Loosening of associations b. Circumstantiality c. Perseveration d. Tangentiality
D
A client comes into the clinic with a longstanding history of depression and chronic renal failure. He is on an antidepressant and a diuretic and complains of increased depression, mild confusion, irritability, and overall apathy from being too tired to do anything. The best initial PMHNP action to take at this time is: a. Increase his dose of antidepressant medication to better capture symptoms b. Change him to another antidepressant for better symptom control c. Augment his antidepressant with an atypical antipsychotic medication d. Order a comprehensive metabolic panel
D
A newly graduated PMHNP is working as a case manager for clients with severe mental illness. As required, the PMHNP maintains in-depth records of: A. Appointment history B. Imagine results C. Insurance coverage D. Treatment plans
D
A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine? a. Increase waist circumference b. Extrapyramidal side effects (5HT2A) c. Increase lipids d. Metabolic Syndrome
D
A patient who was diagnosed with Major depressive disorder comes to the clinic for a refill of sertraline (Zoloft). The PMHNP explains that the medication is prescribed for: A. Universal prevention B. Primary prevention C. Secondary prevention D. Tertiary prevention
D
A patient with a diagnosis of schizophrenia has a history of suicidal ideation and suicide attempts. The PMHNP should consider which antipsychotic medication that is the only antipsychotic to reduce the risk of suicide in schizophrenia? A. Abilify (aripiprazole) B. Latuda (lurasidone) C. Invega (Paliperidone) D. Clozaril (Clozapine)
D
Jason misses several appointments. The PMHNP notes she feels resentful toward Jason and is struggling with how to respond to Jason when he finally comes in for his appointment. Which of the following demonstrates a therapeutic response? a. "Jason, since you have missed several appointments, we are closing your case." b. "Jason, it's pretty clear to me that you don't want to be here." c. "Jason, you are ambivalent about seeking treatment." d. "Jason, help me understand what's going on so we can figure out how to proceed."
D
John is a 58-year-old male patient with Bipolar I Disorder has been stable for 5 years on valproate and Seroquel. He was recently started on Flucatisone (Flonase) by his primary care NP. As the PMHNP treating John, you are concerned that the addition of the Flucatisone may cause A. A hypertensive crisis B. Steven-Johnson's Syndrome C. Neuroleptic Malignant Syndrome (NMS) D. A manic episode
D
Patient being treated for psychosis for 2 weeks develop symptoms of NMS. The following factors help PMHNNP to differentiate NMS from serotonin syndrome: a. Autonomic instability, diaphoresis, tremors b. Hyperthermia, leukopenia, tachycardia c. Rigidity, hyperreflexia, orthostatic hypotension Mutism, leukocytosis, myoglobinuria
D
Patient would like to try acupuncture to her routine to help manage her depression. Your best response is: A. Acupuncture is an integrative therapy, but is least effective in improving depression B. Integrative therapies have no effectiveness an improving depressive symptom. C. Integrative studies are not well studied, and I cannot recommend you add this. D. Acupuncture has been found to help some individuals with depression. While data is limited, if this is something you would like to consider, let's talk about where you might find a reputable practitioner.
D
To encourage the patient to talk freely during the interview, the PMHNP: a. Uses direct questioning b. Explains behavior/brain interaction theory c. Takes notes conscientiously d. Provides empathetic response
D
What is the best treatment for AIDS dementia complex? a. Acetylcholinesterase inhibitors b. Symptom-targeted pharmacologic treatments c. Non-pharmacological supportive care d. Antiretroviral therapy
D
When studying pharmacodynamics involving receptors, you know that an agonist produces the following effect: a. Does not fully activate the receptor and causes only limited actions. b. Blocks the agonist from opening the channel and does not activate a biological response. c. Causes the opposite effect of agonist and causes the receptor to close the ion channel. d. Activates a biological response and opens the ion channel.
D
Which nonpharmacological treatment modality is recommended for depression? A. Biofeedback B. Dialectical behavioral therapy C. Eye movement desensitization and reprocessing therapy D. Supportive group therapy
D
Which of the following patient is at a higher risk of suicide? a. A 30-year-old married African American female with previous suicide attempt b. A 35-year-old single Asian male with previous suicide attempt c. A 38-year-old single African-male who is a manager of a bank d. A 68-year-old single Caucasian male with depression
D
While working with an older male client, the nurse begins to think that the client reminds her of her grandfather and responds as if she was the granddaughter. The nurse is developing which of the following? a. Empathy b. Modeling c. Transference d. Countertransference
D
