Wrong PMHNP Questions

Alice is a 68-year-old woman who presents to you with concerns about her memory. She explains that her mother and grandmother both experienced dementia and she wants to do what she can to prevent this terrible disease. Alice is treated for hypertension, which is well controlled; other than that she is in good health. She is socially and physically active and participates in a monthly cooking class, volunteers at her church, and plays bridge twice a week at the senior center. She says, "I understand that I am losing brain cells at my age, but I would still like to keep my mind and body active." Which is the best response to Alice?

"Although most brain development occurs early in life, we still form some new brain cells in a couple of areas of the brain during adulthood. You should continue with your activities because they offer excellent physical and mental health benefits and are neuroprotective." While it was once thought that the brain neurons did not regenerate, we now know that while most brain development happens in early life, we continue to form some new brain cells throughout life. As we age, we need to engage in activities that keep our brains healthy by encouraging this growth. Examples are diet, exercise, socialization, and cognitive stimulation.

In a hospital psychiatric consultation setting, what is one of the most common mental illness diagnoses?

*Adjustment Disorder* Adjustment disorders are very common. They are one of the most common diagnoses given in a hospital psychiatric consultation setting, frequently reaching up to 50 percent. About 5 to 20 percent of patients in an outpatient mental health clinic meet the criteria for this diagnosis as well.

A 49-year-old female arrives in the emergency room. She has a long history of IV drug use. Over the past year, the patient's personality has changed, and she is more withdrawn and subdued. Her memory has deteriorated, and she has lost 45 pounds in the past five months. She complains of weakness and difficulty maintaining her balance. During your examination, she scores 21/30 on the mini-mental status exam.

*Correct answer*: Human immunodeficiency virus Human immunodeficiency virus (HIV) results in a wide spectrum of neuropsychiatric symptoms due to opportunistic infections, neoplasms, or direct infiltration of the central nervous system. HIV-associated dementia presents with motor abnormalities, cognitive impairment and decline, apathy, and social withdrawal. Neurologic findings might include weakness, imbalance, or ataxia. This patient's history of IV drug use and recent rapid weight loss are also indicative of HIV.

What percent of the incarcerated population in the United States has a severe mental illness?

*Correct answer: 15% to 24%* Studies estimate that 15% to 24% of the incarcerated population in the United States has a severe mental illness. Unfortunately, a lack of synchronized care in the critical justice system results in repeated incarcerations and fragmented psychiatric care for this population.

What happens at four weeks in development.

*Correct answer: 4 weeks* At four weeks, landmarks of normal behavioral development include Hands fisted Head sags but can hold head erect for a few seconds Follows moving objects to midline Responds to speech Smiles preferentially at mother

According to the United States Centers for Disease Control and Prevention, who does not need to receive the annual influenza vaccination?

*Correct answer: A healthy 25-year-old male* Healthy individuals between the ages of 19 and 49 are not required to receive the annual influenza vaccine unless they meet any of the criteria below. The following people should always receive the influenza vaccine: Children from six months to 18 years of age Anyone aged 50 years and older Anyone who lives in a nursing home or in a long-term care or assisted living facility Anyone with a chronic health condition including asthma, diabetes, renal or hepatic dysfunction, HIV, and neuromuscular disorders Pregnant women Health care personnel Caregivers of children younger than five years

All of the following are examples of Irvin Yalom's curative factors except:

*Correct answer: Adjourning* Irvin Yalom was the first person to put a theoretical perspective on group work. He identified 10 curative factors that differentiate group therapy from individual therapy: Instillation of hope Universality Altruism Increased development of socialization skills Imitative behaviors Interpersonal learning Group cohesiveness Catharsis Existential factors Corrective refocusing Irvin Yalom also believed that all groups go through specific phases: Pre-group Forming Storming Norming Performing Adjourning

Which circadian rhythm sleep-wake disorder subtype is characterized by falling asleep and waking earlier than desired?

*Correct answer: Advanced sleep phase type* Circadian rhythm sleep-wake disorders are characterized by a mismatch between a person's biological clock and the environment. There are five subtypes: *Delayed sleep phase type:* falling asleep and waking later than desired *Advanced sleep phase type*: falling asleep and waking earlier than desired *Irregular sleep-wake type*: falling asleep and waking at random times *Non-24-hour sleep-wake type*: falling asleep and usually waking progressively later than desired *Shift work type*: sleepiness associated with changes in work schedule Jet lag refers to feeling sleepy or "hungover" after crossing time zones. It is no longer considered a sleep disorder.

The Health Information Technology for Economic and Clinical Health (HITECH) Act was included under which 2009 law?

*Correct answer: American Recovery and Reinvestment Act* In February 2009, President Barack Obama signed into law the American Recovery and Reinvestment Act (ARRA) (Pub. L. 111-5). As a response to the Great Recession, this law aimed to save and create jobs while financing infrastructure, education, health care, and renewable resources. The ARRA includes the Health Information Technology for Economic and Clinical Health (HITECH) Act, which attempts to update the American infrastructure, including the use of electronic health records.

A patient presents with psychosis, dry mouth, hyperpyrexia, mydriasis, restlessness, and tachycardia. What possible psychiatric emergency would you suspect?

*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.

Who should not get shingles vaccine?

*Correct answer: Anyone over the age of 50* Shingles, also known as herpes zoster, is an inflammatory condition where a virus produces painful vesicular eruptions along the nerves from one or more dorsal root ganglia. The shingles vaccine is recommended for anyone older than 50 whether or not they recall having had chickenpox, which is caused by the same virus as shingles. In May 2006, the Food and Drug Administration (FDA) approved a VZV vaccine (Zostavax) for use in people 60 and older who have had chickenpox. In March 2011, the FDA extended the approval to include adults ages 50-59. A new shingles vaccine called Shingrix was licensed by the FDA in 2017 for adults age 50 and older. The shingles vaccine should not be given to: People with a weakened immune system People with HIV, AIDS, or a T-cell count below 200 Patients being treated with high-dose steroids

Lifetime risk of suicide for bipolar disorder? Completed suicide?

*Correct answer: Bipolar disorder* Bipolar disorder accounts for 25 percent of all completed suicides. The lifetime risk of suicide in those diagnosed with bipolar disorder is 15 times greater than that of the general population. These individuals are more likely to complete suicide if they have a history of suicide attempts and have spent the majority of the past year in a depressed episode.

The cerebrum contains all of the following areas of the brain except:

*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.

Use of herbal substances in treating mental disorders is becoming more and more popular. Which herbal substance is used in treatment of insomnia?

*Correct answer: Catnip* Common herbals with psychoactive effects used to treat insomnia: Valerian Catnip Chamomile, which also helps with anxiety Other herbals with psychoactive effects: *Ginkgo* which helps with delirium, dementia, and sexual dysfunction *Black cohosh*, which is used to treat menopausal symptoms, premenstrual syndrome, and dysmenorrhea *Belladonna*, which is used to treat anxiety *Ginseng*, which helps with depression and fatigue

Systemic effects of hyponatremia include all of the following except:

*Correct answer: Convulsions* Other presentations of *hyponatremia* include the following: Apprehension Seizures Coma Hypotension Tachycardia Decreased urine output Weight gain Edema Ascites Jugular vein distension Presentations of *hypernatremia:* Convulsions Pulmonary Edema Thirst Fever Dry mucous membranes Hypotension Tachycardia Low jugular venous pressure Restlessness

According to Irvin Yalom, which curative factor occurs when participants reexperience family conflicts within group therapy?

*Correct answer: Corrective refocusing* Irvin Yalom was the first person to put a theoretical perspective on group work. He identified 10 curative factors that differentiate group therapy from individual therapy: *Instillation of hope Universality: Universality occurs as participants discover that others have similar problems, thoughts, or feelings. Altruism: Altruism results from sharing oneself with another. Increased development of socialization skills Imitative behaviors Interpersonal learning: Interpersonal learning allows participants to increase their adaptive interpersonal relationships through group therapy sessions. Group cohesiveness Catharsis Existential factors Corrective refocusing* *Corrective refocusing occurs when participants reexperience family conflicts in the group. These experiences allow them to recognize and change their problematic behaviors.*

Alcohol dependence has increased or decreased triglycerides?

*Correct answer: Decreased triglycerides In alcohol dependence, triglycerides are usually elevated.* Alcohol dependence and abuse produce characteristic laboratory findings, including the following: Elevated mean corpuscular volume (MCV) Increased prothrombin time Aspartate aminotransferase (AST) elevation greater than 40% Alanine aminotransferase (ALT) elevation greater than 20% Elevated amylase Low white blood cell count Elevated uric acid Elevated triglycerides

According to Erik Erikson, during which psychosocial stage would you expect a person to develop a sense of unity in life's accomplishments?

*Correct answer: Ego Integrity vs. Despair* Ego Integrity vs. Despair is the final stage of psychosocial development. Successful resolution of this stage is characterized by a sense of unity in life's accomplishments. Failure to resolve this stage leads to regret over lost opportunities of life. Erik Erikson's stages of psychosocial development: *Trust vs. Mistrust*: birth to 12-18 months *Autonomy vs. Shame and Doubt*: 12-18 months to 3 years *Initiative vs. Guilt:* 3 to 5-6 years *Industry vs. Inferiority*: 5-6 years to adolescence *Identity vs. Role Confusion*: adolescence to adulthood *Intimacy vs. Isolation*: adulthood *Generativity vs. Stagnation:* middle adulthood *Ego Integrity vs. Despair*: late adulthood

What term is defined as tension between what one wants to do and what is morally right?

*Correct answer: Ethical conflict* Ethical conflict is defined as the tension between what one wants to do and what is morally right. Ethical dilemmas are conflicts between different ethical perspectives. Ethics is the branch of knowledge that deals with moral principles. Professional ethics refers to the branch of knowledge that deals with moral behavior when in a professional role.

According to Irvin Yalom, what would you expect to occur during the forming phase of group therapy?

*Correct answer: Expectations are identified and boundaries are established* Irvin Yalom was the first person to put a theoretical perspective on group work. He believed that all groups go through specific phases: Pre-group Forming Storming Norming Performing Adjourning During the forming phase: Members appear concerned about self-disclosure and rejection Goals and expectations are identified Boundaries between the leader and participants are established Trust and rapport begin to develop

Belladonna is a common non-psychoactive herbal supplement used to cure illness and maintain health.

*Correct answer: False* Belladonna is a psychoactive herbal supplement that produces psychological effects believed to aid in relieving psychiatric symptoms. Practice of herbal medicine originated in China and is the oldest system of medicine. This method of healing relies on plants to cure illnesses and maintain health. Similar to prescription medications, many plants contain active compounds that produce physiological and psychological effects. Food and Drug Administration approval is not required; thus, no uniform standards ensure quality control or potency.

The four major dimensions of recovery include health, home, continuity, and community.

*Correct answer: False* The four major dimensions of recovery include health, home, purpose, and community.

Each of the following is a culture-related term for describing panic attacks except:

*Correct answer: Fearful spells* Cultures across the world describe panic attacks using different phrases or terms: *Vietnamese*: "Hit by the wind" *Latin Americans*: "Attack of the nerves" *Cambodians*: "Soul loss" "Fearful spells" refers to a limited symptom attack that does not meet the full criteria for a panic attack.

All of the following are true regarding females with bipolar disorder except:

*Correct answer: Females are more likely to develop psychotic features* Gender does not appear to be related to the likelihood that someone with a bipolar disorder will develop psychotic features. Females with bipolar disorder are more likely to experience rapid cycling and mixed states and are more likely to experience depressive episodes. They also have higher rates of comorbid alcohol use disorders and eating disorders.

Which of the following is a common non-psychoactive supplement used to help cure symptoms of illness and maintain health?

*Correct answer: Fish oil* Fish oil is a common non-psychoactive supplement used to cure symptoms of illness and maintain health. Other common non-psychoactive dietary supplements with physiological (not psychological) effects used to cure illnesses and maintain health are as follows: Omega-3 fatty acids Tryptophan Vitamin E Melatonin SAM-e St.-John's-wort is a psychoactive herbal supplement. Magnesium is an electrolyte supplement. Belladonna is a psychoactive herbal supplement.

Competence to be executed was established in what Supreme Court case?

*Correct answer: Ford vs. Wainwright* Competency to be executed was established in the Supreme Court case of Ford vs. Wainwright. The requirements to establish the competence to be executed are as follows: The person must be aware of the retributive element of punishment. The person must be in the best position to make whatever peace is appropriate with his or her religion. Someone who is determined competent to be executed preserves the right to recall a forgotten detail of the crime that may prove exonerating. Most national medical organizations agree that it is unethical for any clinician to participate in state-mandated executions. Rather, nurse practitioners have a duty to preserve life, and this transcends any other competing requirements. The 1976 case of O'Connor vs. Donaldson ruled that harmless mentally ill patients cannot be confined against their will if they can survive outside. This case determined that the presence of a mental illness alone cannot justify involuntary hospitalization. In 1979, Rennie vs. Klein determined that patients have the right to refuse any treatment and use an appeal process. Durham vs. United States determined that an individual is not criminally responsible if the unlawful act was the product of mental illness. This case is known for originating the insanity defense.

You are the nurse practitioner treating a 19-year-old female. During your initial assessment, the client complains of not sleeping well. You understand that disruptions in sleep patterns have etiology in all of the following except:

*Correct answer: Genetics* Genetics have not been substantiated as being an etiological cause of insomnia. The etiology of insomnia is found in the following: Dysfunction in sleep-wake circuits of the brainstem Neurochemical imbalances impinging on these circuits May be stress-related in brief episodic insomnia

Health Information Technology for Economic and Clinical Health Act?

*Correct answer: Health Information Technology for Economic and Clinical Health Act* In February 2009, President Barack Obama signed into law the American Recovery and Reinvestment Act (ARRA) (Pub. L. 111-5). As a response to the Great Recession, this law aimed to save and create jobs while financing infrastructure, education, healthcare, and renewable resources. The ARRA includes the Health Information Technology for Economic and Clinical Health (HITECH) Act, which attempts to update the American infrastructure, including the use of electronic health records.

What term best describes the organizational and institutional structures through which an economy makes choices regarding the production, consumption, and distribution of medical services?

*Correct answer: Health care system* *Health care system* describes the organizational and institutional structures through which an economy makes choices regarding the production, consumption, and distribution of medical services. *Health production function* is a mathematical expression that shows the relationship between an individual's health and a number of other variables, including the amount of health care consumed. A *health alliance* is a public agency that uses its bargaining power to negotiate competitive prices for health insurance from the private insurance market. *Health economics* is related to the value, effectiveness, and efficiency of care received.

What term best describes the relationship between an individual's health and a number of other variables, including the amount of health care consumed?

*Correct answer: Health production function* Health production function is a mathematical expression that shows the relationship between an individual's health and a number of other variables, including the amount of health care consumed. Health care system describes the organizational and institutional structures through which an economy makes choices regarding the production, consumption, and distribution of medical services. Health economics is related to the value, effectiveness, and efficiency of care received. Health alliance is a public agency that uses its bargaining power to negotiate competitive prices for health insurance from the private insurance market.

Mrs. Kemp is voluntarily admitted to the hospital. After 24 hours, she states she wishes to leave because "this place can't help me." The best nursing action that reflects the legal right of this client is

*Explain that the client cannot leave until you complete further assessment.* Almost every state allows for a brief period of detainment to assess a client for dangerousness to self or other before allowing the client to leave hospital settings, even if admission is voluntary

What findings are important to collect in anorexia?

*Correct answer: Height and weight* This patient presents with symptoms indicative of anorexia nervosa. Height and weight will help you establish the severity of her diagnosis. Individuals with anorexia nervosa achieve or maintain a significantly low weight. Severity of anorexia nervosa is characterized as mild, moderate, severe, or extreme, depending on the patient's BMI: *Mild*: BMI greater than or equal to 17 *Moderate*: BMI between 16 and 16.99 *Severe:* BMI between 15 and 15.99 *Extreme*: BMI less than 15

What mental illness affects males and females equally, worsens with each decade of life, is three times more prevalent in older adults, and is associated with indecisiveness, procrastination, avoidance, and difficulty organizing tasks?

*Correct answer: Hoarding disorder* Hoarding disorder affects males and females equally, worsens with each decade of life, is three times more prevalent in older adults, and is associated with indecisiveness, procrastination, avoidance, and difficulty organizing tasks. Once symptoms begin, hoarding behaviors usually become chronic. About 80 to 90 percent of individuals with hoarding disorder display excessive acquisition, most commonly in the form of excessive buying or excessive collection of free items. A less common type of this disorder is called animal hoarding. In animal hoarding, individuals accumulate a large number of pets and fail to provide them with minimal standards of nutrition, sanitation, or veterinary care.

Rett syndrome is known as the development of specific deficits following a period of normal functioning after birth. You are a nurse practitioner performing an assessment on a new six-year-old female patient. You pay close attention to her mental status and perform a mental status exam. All of the following presentations are expected with Rett syndrome except:

*Correct answer: Inattentiveness* Children with Rett syndrome present with the following: 1. Flat or blunted affect. 2. Impairment of expressive and receptive language 3. Stereotypic hand movements Inattentiveness is a characteristic of children presenting with ADHD, not Rett syndrome.

Which of the following is considered an environmental risk factor?

*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.

Failure to resolvem psychosocial stages

*Correct answer: Initiative vs. Guilt* Failure to successfully resolve the psychosocial stage Initiative vs. Guilt is associated with the later development of conversion disorder. Erik Erikson's stages of psychosocial development: Trust vs. Mistrust: birth to 12-18 months Autonomy vs. Shame and Doubt: 12-18 months to 3 years Initiative vs. Guilt: 3 to 5-6 years Industry vs. Inferiority: 5-6 years to adolescence Identity vs. Role Confusion: adolescence to adulthood Intimacy vs. Isolation: adulthood Generativity vs. Stagnation: middle adulthood Ego Integrity vs. Despair: late adulthood Failure to resolve Trust vs. Mistrust is associated with psychosis, addictions, and depression. Failure to resolve Autonomy vs. Shame and Doubt is associated with paranoia, obsession, compulsions, and impulsivity. Failure to resolve Industry vs. Inferiority is associated with creative inhibition.

All of the following statements are true about gray matter except

*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.

According to Freud, during what psychosexual stage of development are sexual concerns largely unimportant?

*Correct answer: Latency stage* Freud's stages of psychosexual development: Oral: birth to 12-18 months Anal: 12-18 months to 3 years Phallic: 3 to 5-6 years Latency: 5-6 years to adolescence Genital: adolescence to adulthood The latency stage is characterized by a time in which sexual concerns are largely unimportant. During this phase, children establish decisive patterns of adaptive functioning. They develop a sense of industry and a capacity for mastery of objects. This is the phase in which children develop a foundation for mature adult life satisfaction.

As many as 50% of all alcohol-dependent suicide victims have experienced which of the following in the previous year?

*Correct answer: Loss of a close, affectionate relationship* As many as 50% of all alcohol-dependent suicide victims have lost a close, affectionate relationship in the past year. Alcohol-dependent suicide victims tend to be white, middle-aged, unmarried, friendless, socially isolated, and currently drinking. Forty percent have made a previous suicide attempt. Those with comorbid antisocial personality disorder are at an even higher risk of suicide.

Pts w/ OCD also have what other disorder?

*Correct answer: Major depression* Obsessive-compulsive disorder is highly comorbid with other psychiatric conditions: 67% have major depression 25% have social phobia 20-30% have a tic disorder Rates of OCD are also elevated in individuals with schizophrenia, schizoaffective disorder, bipolar disorder, eating disorders, and Tourette syndrome.

An 18-year-old female arrives at your office with a chief complaint of "nervousness." After your full evaluation, you diagnose her with unspecified anxiety disorder and prescribe sertraline. You administer the Hamilton Anxiety Scale to obtain a baseline score, and you plan to monitor her treatment progress by readministering the scale at every follow-up appointment. Her score today is 20. What does this score indicate?

*Correct answer: Moderate anxiety* The Hamilton Anxiety Scale (HAM-A) is the most commonly used clinician-administered anxiety rating scale. It is best used in the evaluation of anxiety severity and tracking the efficacy of anxiety treatments over time. The HAM-A is based on various domains of anxiety including anxious mood, fears, sleep disturbance, somatic complaints, tension, and observed behavior. The severity of each domain is ranked from 0 (not present) to 4 (severe). Scoring is as follows: *Score of 14-17*: Mild anxiety *Score of 18-24*: Moderate anxiety *Score of 25-30*: Severe anxiety

You are a new nurse practitioner opening your own clinic specifically to treat children and adolescents. You have an initial evaluation appointment today with a mother of a six-year-old who is concerned about her daughter's inability to keep up with her schoolwork. You decide to screen for autism spectrum disorder (ASD). All of the following assessments are appropriate for screening this patient for ASD except:

*Correct answer: Modified Checklist for Autism in Toddlers* Although this is an evidence-based and adequate tool, it is for toddlers only; this patient is too old for this assessment tool. Screening for developmental delays is a critical component of assessing for ASD. Checklists for this include the following: Modified Checklist for Autism in Toddlers (Age-Specific) Autism Diagnostic Observation Schedule-Generic (ADOS-G) Ages and Stages Questionnaires Parents may also report the following symptoms: No cooing by age one year, no single words by age 16 months, no two-word phrases by age 24 months Loss of language skills No imaginary play Little interest in playing with other children Extremely short attention span No response when called by name Little or no eye contact Intense tantrums Fixations on single objects Unusually strong resistance to changes in routines Oversensitivity to certain sounds, textures, or smells Appetite or sleep-rest disturbance, or both Self-injurious behavior

A young woman brings her 77-year-old father to a clinic. She believes her father has Alzheimer's disease because he has been depressed and forgetful lately. What are the earliest symptoms of Alzheimer's disease?

*Correct answer: Mood changes* The onset of symptoms in Alzheimer's disease follows this progression: (1) mood changes, (2) cognitive impairment, (3) decline in functional independence, (4) behavioral and motor symptoms. Mood changes are usually manifested as apathy rather than depression and are resistant to antidepressant medications but responsive to cholinesterase inhibitors.

What type of phobia is experienced equally by both genders?

*Correct answer: Needles* There are five categories of phobias: Animal (spiders, insects, dogs, etc.) Natural environment (heights, storms, water, etc.) Blood-injection-injury (needles, invasive medical procedures, blood transfusions, etc.) Situational (elevator, airplane, enclosed places, etc.) Other (situations that may lead to vomiting, loud sounds, costumed characters, etc.) Men and women experience blood-injection-injury phobias at equal rates. Women are more likely than men to experience animal, natural environment, and situational phobias.

A 47-year-old female arrives at the emergency room accompanied by the police, who found her "confused and walking strangely." During your examination, you notice pupil abnormalities, depressed deep tendon reflexes, and a positive Romberg sign. She reports a long history of IV drug abuse. In the past, she was prescribed an antipsychotic, but she states she has not taken that medication for years. What do you suspect?

*Correct answer: Neurosyphilis* Even though syphilis infections have been declining since World War I, it is important to consider them in a differential diagnosis for a variety of psychiatric presentations. Neurosyphilis is syphilis that involves the central nervous system. Symptoms of neurosyphilis include the following: Wide-based gait Positive Romberg sign Loss of vibratory and proprioceptive senses in lower extremities Decreased deep tendon reflexes Pupil abnormalities Tremors Dyscoordination Spasticity in lower extremities The patient has not taken antipsychotic medications for years, so her symptoms are likely unrelated to neuroleptic malignant syndrome (NMS). Neuroleptic malignant syndrome is a rare but life-threatening idiosyncratic reaction to neuroleptic medications that is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction. NMS often occurs shortly after the initiation of neuroleptic treatment, or after dose increases. Wernicke's syndrome, also known as Wernicke encephalopathy, is a neurological disease characterized by the clinical triad of confusion, the inability to coordinate voluntary movement (ataxia), and eye (ocular) abnormalities. Her symptoms cannot be explained by Wernicke encephalopathy. Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B1). Korsakoff syndrome is most commonly caused by alcohol misuse and is often, but not always, preceded by an episode of Wernicke encephalopathy. Her symptoms cannot be explained by Korsakoff psychosis.

A 21-year-old female presents to her primary care provider because she has stopped menstruating. She is a thin, athletic woman with poor dental hygiene and erosion of her tooth enamel. Her weight is slightly below average but within normal limits. She describes herself as "a little weird" about her weight, and she sometimes exercises heavily after eating a big meal. What laboratory findings would you expect with this patient?

*Correct answer: Normal thyroid function* This patient presents with symptoms suggesting a binge eating and purging disorder, such as bulimia. Bulimia does not usually affect thyroid function; therefore, you would expect normal thyroid levels in this patient. Other laboratory findings in patients with bulimia might include the following: Hypokalemia Hypochloremia High serum amylase Hypomagnesemia

You are a new nurse practitioner opening your own clinic specifically to treat children and adolescents. You have an initial evaluation appointment today with a mother of a 15-year-old who is concerned about her daughter's severe weight loss and frequent blackouts. The mother indicates that her daughter is fixated on caloric intake and exercising. During your screening process, the patient endorses that she has not had her menstrual period for eight months. To further understand the progression of a potential eating disorder, you order labs and want to pay specific attention to what?

*Correct answer: Normochromic, normocytic, or general anemia* This patient is presenting with a history of severe weight loss, halted menstrual periods, and blacking out. An important part of the assessment is to check the patient for anemia. Other lab changes to assess for in patients with eating disorders include the following: Leukopenia Neutropenia Thrombocytopenia Hypokalemia Hypomagnesemia Hypoglycemia Decreased LH and FSH Cardiomyopathy (enlarged heart muscle), Wolff Parkinson White (WPW) syndrome, and increased HDL and LDL are not relevant key findings in eating disorders.

If a patient threatens to commit suicide, what legal doctrine allows a nurse practitioner to involuntarily admit them to a psychiatric hospital?

*Correct answer: Parens patriae* The criteria for involuntary admission comes from the legal doctrines of police power (state as protector) and parens patriae (state as parent). Parens patriae allows the state to intervene and act as a surrogate parent for those unable to care for themselves or who may harm themselves. Police power allows the state to intervene if the patient is a danger to others.

Medicare Coverage Parts

*Correct answer: Part C* The Medicare program has four parts: Part A, Part B, Part C, and Part D. Part A: Coverage for hospitalizations (up to 90 days), skilled nursing facility (up to 100 days), hospice (up to six months for terminally ill), and some home health care Part B: Coverage for ambulatory practitioner service; physical, occupational, and speech therapy; medical equipment; diagnostic tests; and some preventative care Part C: Optional coverage for beneficiaries who can choose to receive all of their health care services through one of the provider organizations covered under the Medicare Advantage plan Part D: Optional coverage for outpatient pharmaceuticals

Which part of Medicare provides optional coverage for outpatient pharmaceuticals?

*Correct answer: Part D* The Medicare program has four parts: Part A, Part B, Part C, and Part D. Part A: Coverage for hospitalizations (up to 90 days), skilled nursing facility (up to 100 days), hospice (up to six months for terminally ill), and some home health care Part B: Coverage for ambulatory practitioner service; physical, occupational, and speech therapy; medical equipment; diagnostic tests; and some preventative care Part C: Optional coverage for beneficiaries who can choose to receive all of their health care services through one of the provider organizations covered under the Medicare Advantage plan Part D: Optional coverage for outpatient pharmaceuticals

Outcomes management uses variance data to change a system of health care practice. All of the following are sources of variance except:

*Correct answer: Patient survey* Outcomes management is the use of aggregate variance data to change a system of health care practice. Variance is any event that alters patient progress toward expected outcomes. Sources of variance include practitioner behavior (competency), the severity of illness (with high-risk patients), and practice patterns that either expedite care or inhibit delivery of care. Patient surveys are unique to each patient and do not provide variance of practice. The patient is not considered a source of variance when it comes to outcomes management. The focus in outcomes management is system-based and concerned with how the system of care can be improved for better patient outcomes.

In what phase of group therapy will the leader consider the direction and framework of the group?

*Correct answer: Pregroup* In the *pregroup phase*, the leader will consider the direction and framework of the group. In the *forming phase*, goals and expectations are identified and boundaries established. In the *storming phase*, the leader is to allow expression of both positive and negative feelings and assist the group in understanding underlying conflicts and nonproductive behaviors. In the *norming phase*, the leader allows for open and spontaneous communication, and norms are established.

Which of the following is true regarding the incidence and demographics of those who suffer from or are at risk for bipolar-type disorders?

*Correct answer: Prevalence in males and females is the same* Bipolar disorder is less common than major depressive disorder. Furthermore, 0.7% of the general population is at risk, it affects 2.3 million American adults, it has a mean onset age of early 20s, it may present in childhood or adolescent years, and prevalence is the same for both males and females.

Mean, median, mode, and range are examples of descriptive statistics. Which statistic is defined as the difference between the lowest and highest values?

*Correct answer: Range* Range is the difference between the lowest and highest values. Mode is the value occurring most often. Mean is the average of values. Median is the middle value when the values are listed in numerical order.

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?

*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

A nurse practitioner volunteering on a disaster response team following a terrorist bombing is engaging in what type of public health prevention strategy?

*Correct answer: Secondary prevention* A nurse practitioner volunteering on a disaster response team following a terrorist bombing is engaging in a secondary prevention strategy. Secondary prevention is aimed at decreasing the prevalence of mental disorder. In this scenario, the psychiatric nurse practitioner is providing prompt and early screening for acute stress reactions following the bombing.

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?

*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. two main SARIs prescribed in the United States are:3 Trazodone (previous trade names include Desyrel, Oleptro). Nefazodone (previously marketed as Serzone).

What focused method of therapy is being used when a provider seeks to view symptoms as metaphors in the hierarchal structure of the family unit?

*Correct answer: Strategic therapy* Strategic therapy, originated by Jay Haley, is a method in which interventions are both symptom- and problem-focused. Symptoms are viewed as metaphors and reflect problems in the hierarchal structure. Symptoms are a way to communicate metaphorically within the family. Solution-focused therapy, originated by Steve deShazer, Bill O'Hanlon, and Insoo Berg, is a method where the provider focuses on effective resolution of problems through cognitive problem-solving and use of personal resources as strengths. Structural family therapy, originated by Salvador Minuchin, is a model that places emphasis on how, when, and to whom family members relate in order to understand and then change the family's structure. Family systems therapy, originated by Murray Bowen, is used to increase the family's awareness of each member's function within the family and to increase levels of self-differentiation.

There are four levels of systems: microsystems, macrosystems, megasystems, and metasystems. In health care, what is an example of a megasystem?

*Correct answer: The American health care system* Organizational knowledge and systems thinking add an imperative dimension to nursing science. Nurse practitioners understand that organizations are systems in motion with complex relationships between many different parts. There are four levels of systems: microsystems, macrosystems, megasystems, and metasystems. Microsystem: direct patient care Macrosystem: hospitals, skilled nursing facilities, clinics Megasystem: American health care system Metasystem: economic, political, and social level of society

Which of the following patient characteristics would suggest that their psychiatric symptoms are actually due to a physical illness?

*Correct answer: The patient is more than 40 years old* Signs, symptoms, and historical information can suggest an underlying physical condition. A physical cause for psychiatric symptoms is most likely if the patient is having their first episode of mental illness or is more than 40 years old. Persons younger than 20 can develop psychiatric conditions, and estimates suggest that 1 in 5 people will experience a mental illness. A decreased appetite or early morning waking could indicate major depression.

Regarding nurse practitioner standards of practice, all of the following statements are true except:

*Correct answer: There are broad variations from state to state due to outdated legislation* Nurse practitioner scope of practice: Defines the nurse practitioner's roles and actions Identifies competencies assumed to be held by all nurse practitioners who function in a particular role Has broad variations from state to state due to outdated legislation Nurse practitioner standards of practice: Give authoritative statements regarding the quality and type of practice that should be provided Offer a way to judge the nature of care provided Reflect the expectation for the care that should be provided to patients Reflect professional agreement focused on the minimum levels of acceptable performance Can be used to legally describe the standard of care May be either precise or general guidelines Reflect one guideline applicable to all psychiatric nurse practitioners regardless of their practice location

Which of the following is most likely to be a goal of family systems therapy?

*Correct answer: To increase levels of self-differentiation* Family systems therapy was developed by Murray Bowen, who believed that an individual's problematic behavior may serve a function or purpose for the family. This therapy focuses on the chronic anxiety within families. Treatment goals of family systems therapy include increasing self-differentiation, which helps family members learn that their self-worth is not dependent on external relationships, circumstances, or occurrences. Changing family structure is a goal of structural family therapy. Developing nurturing communication is a goal of experiential therapy. Helping family members behave in ways that will not perpetuate the problem behavior is a goal of strategic therapy.

What is systems thinking?

*Correct answer: To produce what it produces* In systems thinking, the belief is that a system is perfectly designed to produce what it produces. The belief is that whatever comes from a system is what the system was designed to produce, regardless of whether the design of the system was planned or unplanned and whether the results were intended or unintended.

Mental status exam findings of those suffering from major depressive disorders include having an unkept appearance; being tired-looking; wearing dark-colored, loose-fitting clothes; and having significant weight changes.

*Correct answer: True* The following are specific attributes often found in those suffering from major depressive disorders: Unkept appearance Tired appearance Wearing dark-colored clothing Wearing loose-fitting clothing Significant weight gain or loss

Strategies for reducing homelessness include all of the following except:

*Correct answer: Urgent and acute treatment of symptoms of homeless individuals who are mentally ill* Although urgent and acute treatment of symptoms of homeless individuals is a part of treatment, it has little to no lasting effect when this is the only treatment provided, as it is not sustainable and not supportive in the long-term goal of reducing homelessness. Strategies for reducing homelessness include the following: Outreach: Introducing services to homeless persons with serious mental illness in various settings; building an empathetic, consistent, and caring relationship to provide treatment. Integrated care: Treatment combining mental health and medical care to improve overall functioning in the community. Can do this by providing colocation of mental health and primary care at a single site. Supportive services in housing: Moving homeless persons with serious mental illness directly to independent housing with support and intensive attention. Prevention: Beginning with discharge planning in inpatient settings, provide resources for mental health care, housing, transitioning service, and follow-up.

For an act to be considered criminal, it must have two components: actus reus and mens rea. What is actus reus?

*Correct answer: Voluntary conduct* For an act to be considered criminal, it must have two components: actus reus and mens rea. Actus reus refers to voluntary conduct. Voluntary conduct is deemed impossible if the offender's mental status is deficient, abnormal, or diseased in a way that inhibits rational intent. Mens rea refers to evil intent. Evil intent is defined as the resolve to do harm. Neither behavior nor intent alone is enough to convict a person of a crime.

Systemic effects of hypernatremia include all of the following except:

*Correct answer: Weight gain* Other presentations of hypernatremia: Convulsions Pulmonary edema Dry mucous membranes Tachycardia Low jugular venous pressure Restlessness Presentations of hyponatremia: Lethargy Headache Confusion Apprehension Seizures Coma Hypotension Tachycardia Decreased urine output Weight gain Edema Ascites Jugular vein distension

A patient presents with oculomotor disturbances, cerebellar ataxia, and mental confusion. What psychiatric emergency would you suspect?

*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. Other presentations 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.

Descriptive statistics

*Correct answer: p-value* Descriptive statistics are used to describe the basic features of the data in a study. They are numerical values that summarize, organize, and describe observations. Examples include mean, standard deviation, and variance. Inferential statistics are numerical values that enable a researcher to draw conclusions that extend beyond the immediate data alone. Examples include t-test, analysis of variance, Pearson's r correlation, probability, and p-value.

Which inferential statistic determines whether the means of two groups are statistically different from each other?

*Correct answer: t-test* Inferential statistics are numerical values that enable one to reach conclusions that extend beyond the immediate data alone. Examples include: *t-test*: assesses whether the means of two groups are statistically different from each other *Analysis of variance (ANOVA)*: tests the difference among three or more groups *Pearson's r correlation*: tests the relationship between two variables *Probability*: the likelihood of an event occurring *p-value (level of significance)*: describes the probability of a particular result occurring by chance alone. For example, if p = 0.01, there is a 1% probability of obtaining the result by chance alone.

According to Freud, successful resolution of which psychosexual stage provides the basis for the development of personal autonomy and capacity for self-confidence?

*Freud's stages of psychosexual development:* *Oral*: birth to 12-18 months *Anal*: 12-18 months to 3 years *Phallic*: 3 to 5-6 years *Latency*: 5-6 years to adolescence *Genital*: adolescence to adulthood Successful resolution of the anal stage of psychosexual development provides the basis for the development of personal autonomy and capacity for self-confidence. Failure to resolve the anal stage results in pathological traits of excessive orderliness, stubbornness, willfulness, frugality, and parsimony. Anal characteristics and defenses are typically seen in obsessive-compulsive disorders.

A community has an unusually high incidence of depression and drug use among the teen- age population. The public health nurses decide to address this problem, in part, by modifying the environment and strengthening the capacities of families to prevent the development of new cases of depression and drug use. What is this is an example of?

*Primary prevention* This action focuses on the interventions designed to reduce the incidence of new cases of disease.

Mr. Smithers, an involuntarily hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered medication because he believes "Jesus Christ told me I am the prophet and must fast for a year." Your actions should be based on your knowledge of which of the following?

*Psychiatric Clients can refuse treatment.* As with any client, psychiatric clients can refuse treatment unless a legal process resulting in involuntary commitment or mandatory court order for treatment has been obtaind.

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

*Psychic determinism of people* The psychic determinism principle states that all behavior has purpose and meaning, often unconscious in nature, and that no behaviors occur randomly.

An example of a mature, healthy defense mechanism is?

*Sublimation* Suppression is the only defense mechanism listed in which the client channels conflicting energies into growth-promoting activities.

Which is true about pharmacologic treatment of anxiety in older adults?

Drugs that are highly oxidized are more unpredictable than drugs that are mostly conjugated. Liver enzymes functioning diminishes as we age.

What four elements need to be present for a malpractice lawsuit to be filed?

Duty of care, breach of standard of care, injury must be r/t to breach of the standard of care.

One of the health care changes that has occurred as a result of the affordable care act (ACA) is that doctors/hospitals/clinic groups or health systems are coming together and assum- ing the responsibility for quality care to large groups of individuals insured by Medicare. The review Questions 389 health care clinics/systems doctors or hospitals that join together are called which of the following?

Accountable Care Organizations (ACOs) Are a groups of doctors or other providers who voluntarily come togrther and assume the care provided to medicare patients.

As a PMHNP, you understand the genetic factors that contribute to psychiatric and personal- ity disorders. Persons who develop antisocial personality disorder often are raised in families with high rates of which of the following?

Alcohol use disorders Being raised in alcoholic family increases the likelihood of chaos, unprediactability, and lack of rules and order, leading to higher rates of developing antisocial personality disorder.

The neurobiological theory of schizophrenia implicates three areas of neurobiological functioning: genetics, neurodevelopment, and neurobiological deficits. False True Hide ExplanationFlag Question

All three areas of development are implicated in schizophrenia. There are genetic and biological components that contribute to schizophrenia as well as development of the brain and environmental factors that contribute to neurodevelopment.

Treatment for Aids dementia complex

Anti-retroviral therapy

Which mental illness is more common in high-income countries than in low-income countries?

Bipolar Disorder

Systemic effects of hyponatremia include which of the following?

Confusion

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?

Correct answer: D = Drugs E = Electrolyte abnormality L = Low oxygen saturation I = Infection R = Reduced sensory input I = Intracranial U = Urinary or renal retention M = Myocardial The other options are not correct mnemonics for assessing delirium.

When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons?

Decreased body fat Older adults usually decreased protein levels. Most medications are highly protein-bound. It is the free concentration of the drug that is active; the bound concentration of the drug is inert. Thus, with decreased protein available for binding, more free active drug remains in the body, which then predisposes older adults to toxicity.

Decreased levels of sodium (Na) can cause which of the following?

Decreased, levels of sodium (Na) can cause Addison's disease, renal disorders, and gastrointestinal fluid loss from vomiting and diarrhea.

Persons with obsessive-compulsive personality disorder often use isolation as a defense mechanism. Which of the following examples best describes isolation as a defense mechanism?

Describing information with very little affect variation. Isolation is a defense mechanism often used by people w/ OCPD and has to do with affect and emotion rather than getting out and being social.

In order to assess a patient's potential to harm others in addition to themselves, a nurse practitioner might ask what question?

Explanation Details *Correct answer: Are there others who you think may be responsible for what you are experiencing?* To assess a patient's potential to harm others in addition to themselves, nurse practitioners should ask the following questions: Are there others who you think may be responsible for what you are experiencing? Are you having thoughts of harming others? Who? Are there other people you want to die with you? Are there others who you think would be unable to go on without you? For patients who present with thoughts about wanting to harm themselves, nurse practitioners could consider asking: How close have you come to acting on those thoughts? How likely do you think it is that you will act on them in the future? What do you envision happening if you actually killed yourself? Have you made a specific plan to harm yourself? Are guns or other weapons available to you? Have you made particular preparations for your death?

When conducting a neurological examination on a client, the PMHNP asks the client to hold out her arms and stick out her tongue while assessing for tremors. Which cranial nerve is being assessed?

Hypoglossal The tongue is controlled by hypoglossal cranial nerves.

What test must the PMHNP complete after TCAs?

Liver function tests (LFTs) TCAs impact liver.

A 74-year-old married white woman was referred to you by her primary care provider for a psychiatric evaluation. She had a normal medical and neurological examination in the last 2 months. The client presents with her husband of 45 years who states, "My wife is just not the same anymore, she is irritable and asks the same question several times, even though I've answered it many times." The client responds, "Oh, Henry, you do the same thing, it's just a normal part of getting older, and the kids think everything is fine." During the assess- ment you compete the mini mental status examination (MMSE) and the client scores 18 as the PMHNP treating the client, you know the results of her MMSE indicate which level of cognitive impairment?

Moderate cognitive impairment Total score of MMSE 30 25-30 questionable significance 20-25 MILD 10-20 moderate 10 or lower SEVERE

Primary prevention care practice are an essential aspect of the PMHNP role. Which of the following is the best example of a primary care strategy for community behavioral health?

Parenting skills classess for pregnant adolescents

Dialectical behavioral therapy (DBT) affirms dialectical thinking, which involves examining and discussing opposing ideas to find the truth. This philosophy is a supportive principle of DBT training. The central dialectical pattern emphasized in DBT involves the tension between:

Radical acceptance and change DBT emphasis acceptance of the current reality of what is and the ability to engage in personal change.

Serotonin is produced in which of the following locations:

Raphe Nuclei

Validating is a communication technique used by the PMHNP when responding to a client about their intentions and treatment goals in the context of the client's noncommittal approach to treatment.

Recognizing, not validating, is a communication technique used by the PMHNP when responding to a client about their intentions and treatment goals in the context of the client's noncommittal approach to treatment.

Samantha is a 26-year-old partnered woman who works full time as a teacher. She is in a long-term relationship with Mary and they are getting along well, and doing well financially. They have two children, ages 2 and 6. Samantha is seeing the PMHNP to address her concerns that she is feeling down and sad for no reason and states, "I know my life is going well but I just don't feel happy. I have always worried a lot and have been sad most of my life." As a PMHNP trained in transactional analysis (TA), you understand that personality is multifaceted and wonder if which of the following is affecting her ability to experience happiness:

She likely had traumatic event in her childhood and her thoughts and feelings r/t to the event are locked together in her brain and cannot be accessed. According to TA, when a person is traumatized the thoughts and feelings get tied together and the process of therapy is to unlock the two.

Systemic effects of hypernatremia include

Systemic effects of hypernatremia include restlessness, thirst, and fever.

Medicaid vs Medicare

The Centers for Medicare and Medicaid Services (CMS) administer the two major public insurance programs, Medicaid and Medicare. Medicaid is funded by both federal and state tax dollars. In 2011, Medicaid provided health care for 60 million eligible persons, 85% of whom were children. Those eligible for Medicaid include the following: Low-income children Low-income pregnant women Elderly and disabled individuals who qualify for the Supplemental Security Income Program Medicare is funded by federal tax dollars. In 2011, it provided health care for 47 million eligible people. Those eligible for Medicare include the following: The elderly age 65 and older having worked 40 quarters and paid Medicare taxes Certain younger individuals with disabilities Individuals with end-stage renal disease Individuals in need of a kidney transplant Individuals receiving Social Security Disability and who have amyotrophic lateral sclerosis

Alpha-agonists such as clonidine and guanfacine are often used to treat anxiety in children.

True Correct answer: True The FDA has approved certain medications for children in the treatment of anxiety. Due to the safe nature of these pharmaceuticals, they are appropriate for using off-label for anxiety.