Dom2 iq
A family nurse practitioner asks about an antidepressant for a patient who scored a 15 on the Patient Health Questionnaire-9 (PHQ-9). Which of the following is the most appropriate response? - "A score of 15 on the PHQ-9 indicates possible moderate depression. You should start the patient on a serotonin and norepinephrine reuptake inhibitor (SNRI)." - "A score of 15 on the PHQ-9 indicates possible moderate depression. You should start the patient on an antidepressant and refer the patient to therapy." - "A score of 15 on the PHQ-9 indicates possible severe depression. I recommend starting the patient on a selective serotonin reuptake inhibitor (SSRI) and an atypical antipsychotic." - "A score of 15 on the PHQ-9 indicates possible moderately severe depression. I can see this patient today to further evaluate their depressive symptoms and recommend the appropriate treatment."
"A score of 15 on the PHQ-9 indicates possible moderately severe depression. I can see this patient today to further evaluate their depressive symptoms and recommend the appropriate treatment." Scores of 5, 10, 15, and 20 on the PHQ-9 represent cut points for mild, moderate, moderatelv severe, and severe depression. For a score of 15-19, the proposed treatment is pharmacotherapy or psychotherapy. Additionally, the PHQ-9 is a screening instrument, and scores should be used only in tandem with further assessment and evaluation.
During a follow-up medication visit for her 13-year-old son, mother shares concerns about a school notice recommending a human papillomavirus (HPV) vaccination for her son, noting that he isn't sexually active. The best response from the psychiatric-mental health nurse practitioner (PMHNP) is: © "Thank you for sharing your concerns, but you don't need to worry about the HPV vaccine. Only females need to receive this particular vaccine." © "I understand your concerns around talking with your son about sexual activity. Why don't we discuss how to start that conversation and what information to introduce?" © "As I am your son's mental health provider, not his primary care provider, I am unable to provide you with information related to immunizations." © "Decisions about immunizations can be difficult. Most guidelines recommend that males between the ages of 11 and 12, or as young as 9, receive this immunization. What concerns do you have?'
"Decisions about immunizations can be difficult. Most guidelines recommend that males between the ages of 11 and 12, or as young as 9, receive this immunization. What concerns do you have?' The PMHNP's scope and role includes addressing health promotion and risk reduction through discussions about immunizations. The Centers for Disease Control and Prevention (CDC) recommends that all males between the ages of 11 and 12 receive the HPV vaccination, or that they start as early as 9 years of age
In assessing possible sexual abuse of a four-year-old child, the psychiatric-mental health nurse practitioner is asking the child questions. Which question would be least likely to elicit relevant information? © "Has anyone ever taken your picture without your clothes on?" © "Has anyone recently invited you to a birthday party at a pool?" © "Has anyone ever asked you to take off your clothes?" © "Has anyone done something you didn't like to your body?"
"Has anyone recently invited you to a birthday party at a pool?" The invitation of a four-year- old to a birthday pool party is not indicative of sexual context and would require parental involvement in the decision making process. The other three questions directly explore inappropriate behavior of a sexual nature pertinent to assessment for sexual abuse.
An adult patient has been prescribed a selective serotonin reuptake inhibitor (SSRI) for an initial episode of major depression. The patient is fearful of side effects and of becoming suicidal. Which of the following initial responses is most appropriate? © "Have you ever had feelings of hurting yourself? If you took the medication and had those kinds of thoughts, what would you do?" © "Have you ever had feelings of hurting yourself? If you took the medication and had those kinds of thoughts, would you be willing to call the crisis hotline?" © "SSRIs are generally quite safe and rarely cause suicidal thoughts. I could call you every few days to see if you are having any of these thoughts." © "SSRIs are the safest antidepressant medications and rarely cause suicidal thoughts. Try the medication, and we can watch closely for any side effects."
"Have you ever had feelings of hurting yourself? If you took the medication and had those kinds of thoughts, what would you do?" It is important to explore prior or current suicidal thoughts and how the patient would respond if the did have such thoughts. Only suggesting contact with a crisis hotline without suggesting some contact with the provider does not facilitate empathy or rapport. Statements offering reassurance may or may not be true.
A sexually active 15-year-old girl is in counseling. Which is the most effective statement that can be made to influence her behavior? © "Always use condoms when having sex." © "Here are some condoms to use." © "Please ask your partner to use a condom." © "Always carry condoms in your purse."
"Here are some condoms to use." Providing specific steps for risk reduction is more effective than making general statements. Giving an actual condom to an adolescent girl places the responsibility for its use on her. She is more likely to use condoms when initially given a sample by a provider than if she bought them herself.
A mother brings her nine-year-old daughter to the clinic due to the daughter's recurring night terrors, which have been occurring for the past few months. During these events, the daughter wakes up screaming in the middle of the night. She is inconsolable initially, but eventually goes back to sleep. The mother is worried and shares that she also feels exhausted from the daughter's episodes. The most appropriate initial response is: © "Tell me why you are unable to fall back asleep after your daughter does." © "I know you are upset, but it will get better." © "I can see this is very upsetting for you." © "Are you worried that this is your fault?"
"I can see this is very upsetting for you." A simple, nonjudgmental statement such as "I can see this is very upsetting for you" conveys the practitioner's concern. This form of sentence also acts as an open-ended question that will likely elicit the most important information the most efficiently.
A patient who works the night shift presents for a follow-up appointment to see the psychiatric-mental health nurse practitioner (PMHNP). The patient states, "I can't sleep when I get home from work." Upon assessment, the PMHNP learns that the patient recently started an exercise regimen and is now exercising after work. How should the PMHNP advise the patient regarding sleep hygiene? - "Exercising is a good way to help you get to sleep. If you keep up your schedule, your body will adjust to the new routine." - "Regular exercise helps with sleep, so continue to exercise, and when you get home, watch television or play soothing music to help promote sleep." - "Exercise does not promote or help deepen your sleep, so you should consider making changes in your daily routine." - "Reqular exercise can help promote sleep, but it should not be performed too close to your bedtime. Try exercising before work."
"Reqular exercise can help promote sleep, but it should not be performed too close to your bedtime. Try exercising before work." Measures to promote or induce sleep, known as sleep hygiene, include establishing an exercise routine early after waking and avoiding stimulation, such as TV. before going to bed
An opening question or statement by a psychiatric-mental health nurse practitioner that facilitates communication at an initial visit is: © "What seems to be the problem today?" © "Tell me your concerns and how I may be of help." © "What problem does your primary care physician want us to evaluate?' © "Tell me what you think your problem is."
"Tell me your concerns and how I may be of help." An opening statement that facilitates communication seeks the patient's perspective and conveys an offer to help, which conveys empathy, provides hope, and facilitates trust. While open- ended questions are typically better than closed-ended questions in patient-centered counseling, the other questioning options lack empathy.
The psychiatric-mental health nurse practitioner (PMHNP) is questioning a patient regarding alcohol use during an intake The patient states that they only drink socially. The most appropriate initial response is: © "What amount and what kind of alcohol do you drink in a week?" © "Many people with alcohol issues say they are social drinkers." © "I am glad you are a responsible drinker." © "Do other people in your household drink alcohol?"
"What amount and what kind of alcohol do you drink in a week?" This answer clarifies the patient's own answer while eliciting more information.
A 14-year-old girl admitted to a psychiatric unit following an overdose on alcohol and benzodiazepines after the breakup of a relationship has made seductive comments to her roommate. This is upsetting her roommate. In assessing the girl's behavior toward her roommate, the psychiatric-mental health nurse practitioner needs to include the topic of sexual orientation. The best introductory question for this topic is: © "What is your experience in sexual relationships?" © "Are you attracted to girls rather than boys?" © "Did you overdose after breaking up with a girlfriend or boyfriend?" © "Are you sexuallv active?"
"What is your experience in sexual relationships?" Although the other three responses can open the topic, they are closed-ended and can be answered by a simple "yes" or "no" response. The open-ended question introduces the topic in a broad, nonjudgmental way that gives the respondent an opening for providing prior history of relationships both heterosexual and same-sex, possible history of abuse, and thoughts and feelings about her sexual experiences.
Which of the following individuals is at greatest risk for major depressive disorder (MDD)? © A 40-year-old divorced female schoolteacher raising three children © A 28-year-old single woman working toward partner in a large law firm © A 16-year-old male high school honor student who runs cross-country track © A 58-year-old married male computer analyst whose work requires frequent travel
A 40-year-old divorced female schoolteacher raising three children Women have twofold greater prevalence of MDD than men. The mean age of onset of a maior depressive episode is 40, with 50 percent of all patients experiencing onset between the ages of 20 and 50. MDD occurs most often in persons without close interpersonal relationships and in those who are divorced or separated.
A patient diagnosed with schizophrenia and prescribed an antipsychotic medication should be assessed for potential medication side effects on a consistent basis with the use of the: © Dystonia Rating Scale (DRS). © Drug-Induced Extrapyramidal Symptom Scale (DIESS) © Barnes Akathisia Rating Scale (BARS), © Abnormal Involuntarv Movement Scale (AIMS).
Abnormal Involuntarv Movement Scale (AIMS). AIMS is a tool for monitoring potential antipsychotic side effects, such as tardive dvskinesia (TD). The American Psychological Association (APA) quidelines for schizophrenia (2020) recommend screening all patients on antipsychotics for TD and other drug-induced movement disorders, with clinical assessment at every visit and formal evaluation with the use of a tool like AIMS yearly. High-risk patients should be screened every six months.
During an initial evaluation, the psychiatric-mental health nurse practitioner (PMHNP) asks, "What does the phrase 'A rolling stone gathers no moss' mean?" The PMHNP is assessing: Visualization. Fund of knowledge. Abstract reasoning. Conceptualization.
Abstract reasoning. Proverb interpretation can be useful in the assessment of a patient's ability to abstract.
The psychiatric-mental health nurse practitioner (PMHNP) is working with a patient who is experiencing a full manic episode. The patient has a diagnosis of bipolar I and alcohol use disorder-moderate. The PMHNP has a report from the patient's chemical dependency counselor indicating that inpatient chemical dependency counseling is needed. In the past, the patient has not agreed to chemical dependency treatment. The PMHNP assesses the patient and finds a strong odor of alcohol, auditory and visual hallucinations, flight of ideas, lack of sleep for three days, suicidal ideation without a firm plan, and ideas about driving to another state to gamble. The patient's brother, who has accompanied the patient, corroborates this information. In order to best treat this patient, the PMHNP: © Sends the patient home with their brother and a prescription for a new antipsychotic medication. © Admits the patient to the local psychiatric unit with an order for the collection of laboratory values © Admits the patient to the inpatient chemical dependency program. © Admits the patient to the dual diagnosis chemical dependency unit with an order for the collection of laboratory values.
Admits the patient to the local psychiatric unit with an order for the collection of laboratory values If a patient is both manic and of danger to themselves, they should be hospitalized. The patient will not be able to participate in any programming until they are out of acute manic state. Going home is not an option unless the patient has someone who can be with them for at least 24 hours and can monitor their withdrawal from alcohol, manic condition, suicidal ideation, and desire to leave the state.
According to a seminal research study on adverse childhood experiences (ACE), a positive relationship exists between ACE and the development of the following disorders later in life: Alcoholism, anxiety, depression, diabetes, and schizophrenia, Alcoholism, anxiety, depression, diabetes, and heart disease Alcoholism, anorexia, depression, diabetes, and schizophrenia Alcoholism, anxiety, heart disease, sleep disorders, and bipolar disorder.
Alcoholism, anxiety, depression, diabetes, and heart disease The seminal study of Felitti et al. (1988) on the long-term sequelae of ACE found a positive relationship between ACE and significant heart disease, fractures, diabetes, obesity, unintended pregnancy, sexually transmitted diseases, depression, anxiety, sleep disorders, dissociative disorders, eating disorders, and alcoholism.
There are many risk factors for intimate partner violence (IPV). Which of the following individuals is at greatest risk? - A 42-year-old divorced Caucasian woman dating a recently divorced man in Denver, Colorado - A 26-year-old recently separated Asian-American woman living in Boston, Massachusetts - A 35-year-old pregnant Black woman living with her husband in suburb of Dallas, Texas - An 18-year-old Native Alaskan woman living with her employed older boyfriend in Galena, Alaska
An 18-year-old Native Alaskan woman living with her employed older boyfriend in Galena, Alaska The young Native Alaskan woman in a relationship that has age, occupational, and possibly educational disparities is at greatest risk of being a victim of violence IP can affect anyone, but certain populations are at heightened risk, including women, young adults, low- income individuals, people living in poverty or areas with limited educational and economic opportunities, people living in rural areas, pregnant women, LGBTQ+ individuals.
Which of the following lifestyle factors poses the greatest risk for depression, irritability, liver problems, and hypertension in a college student? © Binge drinking © Marijuana use © Anabolic steroid use © Cocaine use
Anabolic steroid use Anabolic steroid use poses the greatest risk among the four lifestyle drug use patterns. Anabolic steroid use is associated with increased irritability and aggression, euphoria, increased energy, sexual arousal, mood swings, distractibility, forgetfulness, increased risk of heart attack, stroke, blood clotting, cholesterol changes, hvpertension, and severe liver problems, including hepatic cancer.
OARS in motivational interviewing (MI) stands for: © Asking open questions, advising, redirecting, and summarizing © Asking open questions, affirming, redirecting, and re-stating. © Asking open questions, affirming, reflecting, and summarizing. © Asking open questions, affirming, responding, and summarizing
Asking open questions, affirming, reflecting, and summarizing. The OARS in MI stands for asking open questions, affirming, reflecting, and summarizing.
The 5As model for health behavior change is an evidence- based approach appropriate for use with a broad range of behaviors and health conditions. The As are: Assess, appraise, agree, access, and arrange Assess, advise, agree, assist, and arrange. Assess, appraise, advise, act, and assist Assess, advise, act, access, and assist.
Assess, advise, agree, assist, and arrange. The 5As model for behavioral counseling and health behavior change are assess advise, agree, assist, and arrange.
A patient began taking antipsychotic medication two weeks ago and now exhibits symptoms such as inability to sit still, frequent pacing, and inner restlessness without reporting anxiety or specific worries. The most appropriate rating scale to assess these symptoms is the: © Abnormal Involuntary Movement Scale (AIMS). © Simpson-Angus Extrapyramidal Side Effects Scale (SAS). © Barnes Akathisia Rating Scale (BARS). © Dyskinesia Identification System Condensed User Scale (DISCUS).
Barnes Akathisia Rating Scale (BARS). The patient is experiencing symptoms consistent with akathisia. The BARS can be very useful in the systematic assessment of patients to identify akathisia, assess its severity, and monitor changes in symptoms.
Regarding risk factors for binge drinking, which of these statements is not accurate? ~ Binge drinking is more common in urban, densely populated areas than in rural, sparsely populated areas. - Binge drinking is more common in Whites than in Blacks or Hispanics - Binge drinking is more common in men than in women. - Binge drinking is most common among younger adults aged 18 to 34.
Binge drinking is more common in urban, densely populated areas than in rural, sparsely populated areas. There is little variation in binge drinking and heavy alcohol use among populations of different densities. There are regional differences in alcohol use, but not specifically in binge drinking rates, with highest alcohol use in western states and lowest use in southern states. The other statements listed here are accurate regarding binge drinking.
A 16-year-old patient with no notable physical or mental history is struggling in the wake of their cousin's death in a rock-climbing accident four months ago. The patient completed the CRAFFT questionnaire; admitted to trying alcohol, but not binge drinking; and admitted to using marijuana several times, with the last use four months ago. The patient has not used other drugs. The patient's CRAFFT score and risk level would be: - CRAFFT = 0. The patient is at medium risk based on responses (past 12-month use, CRAFFT=0). - CRAFFT = 2. The patient is at high risk based on responses (past 12-month use, CRAFFT=2). - CRAFFT = 0. The patient is at low risk based on responses (past 12-month use, CRAFFT=0). - CRAFFT = 1. The patient is at medium risk based on responses (past 12-month use, CRAFFT=1)
CRAFFT = 0. The patient is at medium risk based on responses (past 12-month use, CRAFFT=0). The CRAFFT is a screening tool for ages 1-21, assessing substance use, driving risk, and substance use disorders Two versions exist: clinician and self-administered. Medium risk includes no past 12-month use with a "yes" to the CAR question, or any past 12-month use with a CRAFFT score of 0 or 1. Low risk refers to no past 12-month use and a "no" to the CAR question (CRAFFT score of 0). High- risk involves any past 12- month use with a CRAFFT score of 2 or more.
A 53-year-old patient with a history of schizophrenia is being discharged from a psychiatric hospital. During an initial assessment, the patient is asked about his education level. The patient shares where he went to high school, the names of his high school friends, activities he was involved in, and the events of his high school graduation. He then states, "That was the end of my education." The patient's answer demonstrates: Tangentiality. Loosening of associations. Perseveration. Circumstantiality.
Circumstantiality. Circumstantiality is a disturbance in which a patient digresses into unnecessary details before communicating the central idea.
The phenomenon in which thoughts are associated according to word sounds rather than meaning is: © Flight of ideas. © Clang associations. © Circumstantiality. © Tangentiality.
Clang associations. Clang associations occur when the patient connects thoughts based on word sounds, not meaning. Circumstantiality involves excessive trivial details that delay the patient from reaching the main point. Flight of ideas involves rapidly shifting thoughts that jump abruptly between ideas. Tangentiality occurs when excessive, irrelevant details prevent the patient from ever reaching the point.
A 45-year-old patient diagnosed with alcohol use disorder is admitted to an inpatient substance abuse treatment unit. The most appropriate symptom-triggered approach for managing the patient's treatment is: © Alcohol Use Disorders Identification Test (AUDIT). © CAGE questionnaire. © Michigan Alcoholism Screening Test (MAST). © Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar).
Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar). The CIWA-Ar is a 10-item clinician-rated checklist used to monitor the clinical course of alcohol withdrawal symptoms, including nausea; vomiting; tremor; sweating; anxiety; agitation; tactile, auditory, and visual disturbances; and clouding of sensorium. The other options are all screening tools.
Which of the following screening tests has high sensitivity and specificity in identifying cognitive impairment in older adults while requiring the least amount of time to administer in a clinical setting? © Dementia Rating Scale (DRS) © Global Deterioration Scale (GDS) © Clock Drawing Test (CDT) © Mini-Mental State Exam (MMSE)
Clock Drawing Test (CDT) The CDT is highly correlated with the MMSE, the GDS, and the DRS, yet it takes a minimal amount of time to administer (2-4 minutes). It is well-suited for use in clinical practice settings for screening and monitoring the progression of cognitive decline in older adults.
During an initial assessment, the psychiatric-mental health nurse practitioner asks the patient to perform the serial sevens. Which category of the mental status exam does this assess? Speech Memory Concentration Affect
Concentration Subtracting serial sevens from 100 is a simple task that requires intact concentration and cognitive capabilities.
A patient is asked to count backward by seven, starting at 100. This exercise is meant to assess: © Fund of knowledge. © Recent memory. © Remote memory. © Concentration.
Concentration. Concentration is the ability to sustain focus on a task. The serial 7s are a way to assess concentration. Recent memory is the ability to recall information from the last few minutes. Remote memory is the ability to recall information from the distant past. Fund of knowledge is readily available information, such as on current events or simple geography.
A patient is taking the mini-mental state examination (MMSE) and is copying the diagram of interlocking pentagons. What phenomenon is being tested with this task? Constructional praxis Comprehension Recall Attention and concentration
Constructional praxis Constructional praxis is the ability to draw, manipulate, or copy designs or patterns.
A psychiatric-mental health nurse practitioner (PMHNP) finds themselves frustrated and easily angered by a patient for no clear reason. Upon discussing the situation with a colleague, the PMHNP realizes that the patient reminds them of their abusive stepfather. The PMHNP's emotional response to this patient can best be described as: © Transference. © Countertransference. © Projection. © Displacement.
Countertransference. Countertransference is the term for a mental health care provider's internal reaction to a client. Projection occurs when someone attributes their own unacceptable traits to others. Transference is the redirection of feelings or desires from one person to another. Displacement involves transferring negative emotions from one person or object to another.
A patient reports having felt detached for the past several years. According to the patient, "I just feel fuzzy all the time, like I'm losing touch with reality and not feeling anything much at all." The patient now reports feeling as if they are watching their life in a movie. This patient is most likely experiencing: Derealization. lllusion. Hallucination. Depersonalization.
Derealization. Derealization involves perceiving surroundings and events as detached, distorted or unreal. Depersonalization is the sensation of observing oneself from an external perspective. Hallucinations are seemingly real perceptions without an external stimulus, occurring in any of the five senses. Illusions are misperceptions or misinterpretations of actual perceptions.
The American College of Obstetricians and Gynecologists (ACOG) recommends screening for postpartum depression with a validated screening tool. The ACOG recommended screening tool is the: © Hamilton Depression Rating Scale (HAM-D). © Major Depression Inventory (MDI) © Montgomery-Asberg Depression Rating Scale (MADRS) © Edinburgh Postnatal Depression Scale (EPDS).
Edinburgh Postnatal Depression Scale (EPDS). The EPDS is the screening tool most frequently used in the research setting and clinical practice for several reasons. The scale consists of 10 self-reported questions that are health-literacy appropriate, and takes less than five minutes to complete.
Each of the following is a risk factor for depressive disorders except: Work-related stress. Stressful family life. Family history. Alcohol use.
Family history. Modifiable risk factors are those that can be changed through lifestyle choices and habit. Family history is not a risk factor amenable to lifestyle change.
The family of an 85-year-old patient reports that the patient is no longer able to be managed at home due to verbally abusive and threatening behavior. The most appropriate tool to use in assessing the patient's mood is the: © Mini-Mental State Examination (MMSE). © Geriatric Depression Scale (GDS). © General Health Questionnaire (GHQ). © Patient Health Questionnaire-9 (PHQ-9).
Geriatric Depression Scale (GDS). While there are many instruments available for measuring depression, the GDS has been tested and used extensively with the older population.
A patient reports feeling bugs crawling on their skin. This patient is experiencing the following type of perception: Delusion. Depersonalization. lllusion. Hallucination.
Hallucination. The feeling of bugs crawling on the skin in the absence of any such situation is a tactile hallucination. Hallucinations are seemingly real perceptions that occur without external stimuli and that can be perceived by any of the five senses. Illusions involve misperceptions or misinterpretations of actual perceptions. Delusions are unshakeable false beliefs based on incorrect inferences despite contradictory evidence. Depersonalization is the sensation of observing oneself externally during events and experiences.
When assessing for alcohol use, what does the CAGE questionnaire ask? - Have you ever felt you should Cut down on your drinking? Do you get Angry when you drink? Do you feel Good about your level of alcohol use? Have you ever had an Eye-opener in the morning to get rid of a hangover? - Have you ever felt you should Cut down on vour drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt Guilty about your drinking? Have you ever had an Eye-opener in the morning to get rid of a hangover? - Have you ever felt you should Cut down on your drinking? Do people get Angry when you drink? Do you feel Good about your alcohol use? Have you ever had an Eye-opener in the morning to get rid of a hangover? - Have you ever felt you should Cut down on your drinking? Do you Avoid people when you drink whom you know will disapprove? Do you feel Guilty about your alcohol use? Have you ever had an Eye-opener in the morning to get rid of a hangover?
Have you ever felt you should Cut down on vour drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt Guilty about your drinking? Have you ever had an Eye-opener in the morning to get rid of a hangover? The CAGE questionnaire is used to assess whether or not further evaluation of alcohol use is warranted. It consists of the four questions listed in the correct answer choice.
What is the most important predictor of potential for violence? © History of aggressive rage © History of head injury © History of seizures © History of substance abuse
History of aggressive rage A person's history of previous rage and violent behavior, increasing irritability, persistent angry thoughts, and fear of losing control are the most significant indicators of their potential for violence. Although head injury, substance use or abuse, and temporal lobe epilepsy have been suggested as possible predictors, there is no conclusive evidence to support these claims
An older adult found wandering down the street is asked during the mini-mental state examination (MMSE) to remember three objects. After one minute, the patient is unable to recall the objects. The patient is showing impairment in which type of memory? © Episodic memory © Immediate memory © Anterograde memory © Declarative memory
Immediate memory Immediate (or short-term) memory enables mental operations such as simple calculations and cognitive tasks. Episodic memory pertains to specific life events. Declarative memory involves recallable information. often verbalizable. Anterograde memory refers to the learning and remembering of new information and events following a brain injury.
The Mini-Mental State Exam (MMSE) is a standardized screening tool designed for use: © In individuals age 65 and older to quantify cognitive status © In individuals under 18 years of age to document mental status © On individuals across the lifespan to document mental status. © In individuals age 18 and older to quantify cognitive status
In individuals age 18 and older to quantify cognitive status The MMSE is a concise cognitive assessment tool for adults that evaluates orientation, attention, calculation, recall, language, and motor skills. It is used to detect cognitive impairments. estimate the severity of any impairments, monitor cognitive changes over time, and track an individual's response to treatment.
A patient whose close family member recently died in a tragic accident laughs and makes jokes with others instead of feeling sad. The best term for describing the patient's inner state is: Inappropriate affect. Constricted affect. Labile affect. Alexithymia.
Inappropriate affect. Appropriateness of affect relates to how well emotions align with the situation. Laughing during a solemn moment demonstrates inappropriate affect. Constricted affect involves reduced emotional range and intensity. Labile affect features rapid, exaggerated mood changes and heightened irritability. Alexithymia describes the inability to express, describe, or differentiate emotions.
A 31-year-old woman with a history of anorexia nervosa during her teens and early 20s, now six weeks pregnant, is concerned about the potential impact of her past eating disorder on her pregnancy, the development of the fetus, and her ability to have a full-term delivery. The patient is 5 feet 7 inches, weighs 120 pounds, and maintains her weight through daily 6-10-mile runs and a 2,000-calorie vegan diet. To minimize the risk of triggering her eating disorder and to promote healthy fetal development and a full-term delivery, the psychiatric-mental health nurse practitioner should recommend the following lifestyle modifications: - Increasing daily caloric intake by 250 calories; reducing running to 4-8 miles daily, with reduction in second or third trimester; adding prenatal vitamins and a calcium supplement; and planning for a 20-30-pound gradual weight gain over the course of pregnancy. - Increasing daily caloric intake by 1,000 calories; continuing running as tolerated, with reduction in the second or third trimester; adding prenatal vitamins, a vitamin E supplement, and a B-complex supplement; and planning for a 20-30-pound gradual weight gain over the course of pregnancy. - Increasing daily caloric intake by 700 calories; continuing running as tolerated, with reduction the in second or third trimester; adding prenatal vitamins, a vitamin E supplement, and a B-complex supplement; and planning for a 25-35-pound gradual weight gain over the course of pregnancy. - Increasing daily caloric intake by 500 calories; reducing running to 2-4 miles daily, alternating with stretching and yoga in the second and third trimesters; adding prenatal vitamins and a vitamin B12 supplement; and planning for a 28-40-pound gradual weight gain over the course of the pregnancy.
Increasing daily caloric intake by 500 calories; reducing running to 2-4 miles daily, alternating with stretching and yoga in the second and third trimesters; adding prenatal vitamins and a vitamin B12 supplement; and planning for a 28-40-pound gradual weight gain over the course of the pregnancy. With a BMI of 18.8, the patient has a slightly low weight for her height (normal range: 19.8-26.0). A low pre-pregnancy BMI and inadequate weight gain during pregnancy can increase the risk of spontaneous abortion, pre-term delivery, and low birth weight. Pregnant women should consume an additional 150 calories during the first trimester, 300 calories during the second trimester, and 500 calories during the third trimester, excluding the impact of strenuous exercise. Women with a normal BMI should gain 25 to 35 pounds, while those with a low BMI should gain 28 to 40 pounds. As a vegan diet lacks animal fat-the only dietary source of vitamin B12-the addition of prenatal vitamins and vitamin B12 supplements is recommended.
The degree of awareness and understanding one has of one's own illness is called: Reality testing. Insight. Abstraction. Judgment.
Insight. Insight is the understanding an individual has of how they are feeling, presenting, and functioning as well as of the potential causes of their psychiatric presentation.
In a psychiatric emergency, the psychiatric-mental health nurse practitioner (PMHNP) is aware that the most important goal of the interview is self-protection. What can the PMHNP do to protect their safety? - Know as much about the person as possible before starting the interview - Obtained signed documentation from the patient that the patient knows violence is not acceptable - Enter the room alone to build a therapeutic alliance - Make sure the patient is restrained before beginning the evaluation
Know as much about the person as possible before starting the interview Self-protection involves knowing as much about the patient as possible, being observant of pending violence, having others present or outside the room, and developing an alliance with the patient.
A patient with a history of opioid use disorder is currently experiencing opiate withdrawal and scores a 10 on the Clinical Opiate Withdrawal Scale (COWS). This score is indicative of: © Moderate withdrawal symptoms. © Moderately severe withdrawal symptoms. © Mild withdrawal symptoms © Severe withdrawal symptoms.
Mild withdrawal symptoms The COWS is an 11-item clinician-administered tool for assessing common signs and symptoms of opiate withdrawal and for monitoring symptoms over time. The score can be used to help clinicians determine the stage or severity of the withdrawal and assess the patient's level of physical dependence. The score key is as follows: 5-12 = mild; 13-24 = moderate; 25-36 = moderately severe; more than 36 = severe.
The assessment tool that can measure severitv and track symptom changes is the: © Short Form 36 (SF-36). © Structured Clinical Interview for DSM-5 (SCID-5). © CAGE questionnaire. © Mini-Mental State Examination (MMSE).
Mini-Mental State Examination (MMSE). The MMSE is a rating tool used to screen for dementia that measures the severity of symptoms as well as their progression over time. The SF-36 focuses on functional status over a four-week timespan. CAGE is an alcohol screening tool. The SCID-5 is a diagnostic tool.
A patient diagnosed with depression has a history of suicide attempts from over three ears ago. The patient reports experiencing suicidal ideation over the past few das, but denies intent or plan. The level of suicide risk for this patient is: High. Moderate. Low. None.
Moderate. The patient is at moderate suicide risk because of the previous suicide attempts and the fact that the current ideation is not accompanied by planning.
Having intrusive unwelcome thoughts is representative of the thought content disorder of: Obsession. Compulsion. Hallucination Delusion
Obsession. Obsessional thoughts are intrusive, repetitive ideas. Compulsions involve ritualized behaviors performed to prevent anxiety or a feared outcome. Delusions are false fixed beliefs not shared with any others, while hallucinations are perceptions that occur without corresponding external stimuli.
The psychiatric-mental health nurse practitioner (PMHNP) asks, "What brought you to the clinic today?" This is a(n): © Direct question. © Leading question. © Open question. © Closed question.
Open question. Building a therapeutic relationship is crucial in psychiatric practice. The PMHNP should begin evaluations with open questions such as, "What brought you here today?" or "What can I do for vou?" to encourage the patient to share openly. This approach helps the provider gather comprehensive information.
A psychiatric-mental health nurse practitioner (PMHNP) learns that the adult child of two aging parents has taken on more responsibility for the care of the parents over time. The mother was diagnosed with Alzheimer's disease three years ago, and as her condition has worsened, she has become increasingly disoriented in her home environment. Despite this, the client's father insists on keeping the mother at home and providing care until she passes away. The priority in counseling is: © Anticipatory guidance. © Patient and family education. © Patient safety. © Caregiver strain.
Patient safety. Although all four factors are important aspects of care, patient safety must take priority. In counseling about safety issues such as the risk of wandering, leaving the stove burner on unattended, slipping, or falling, the PMHNP can introduce the other areas of education, anticipatory guidance, and community resources Ensuring the safety of the parents will help reduce caregiver strain.
During what part of an initial psychiatric evaluation would a patient report the use of alcohol and illicit drugs? Review of systems Personal and social history Chief complaint Mental status exam
Personal and social history Habits are included under Personal and Social History
An adolescent patient has recently been in trouble at school for truancy. The patient recognizes that truancy is not a desirable behavior and talks with the psychiatric-mental health nurse practitioner about how to improve school attendance. The student is in which stage of change? © Preparation © Contemplation © Action © Precontemplation
Preparation The student is in the preparation stage of change, having identified an unwanted behavior and begun thinking about how to change it. In the precontemplation stage, the patient is unaware of the issue and has no intention to act. In the contemplation stage, the patient recognizes the problem and weighs the pros and cons, but is mostly ambivalent. In the action stage, the patient has recently taken steps to change and is seeing results.
A 32-year-old woman is upset because of financial disagreements with her husband. She feels sad. has self- harming thoughts, and previously overdosed on Tvlenol. Which of the following factors places her at high risk for suicide? © Previous suicide attempt © Gender © Marital status © Age
Previous suicide attempt Severity and risk factors are usually rated as low, moderate, or high. Factors that increase suicide risk include previous suicide attempts.
In advising parents on reducing the risk of teen substance abuse when there is a positive family history of alcohol dependence, the psychiatric-mental health nurse practitioner encourages all of the following recommendations except: - Random urine testing using home drug testing kits. - Parental networking and supervision of any teen parties. - Parental presence and involvement in the child's school and sports activities. - Acknowledgement of the family risk factor and open discussion with teen
Random urine testing using home drug testing kits. Parental presence, support, and the fostering of a sense of connectedness with teens are primary strategies for reducing risk of teen substance abuse. Home urine testing for alcohol and drugs may be advised for teens who have a demonstrated alcohol or drug problem as part of a rehabilitation contract, but this is not considered a risk reduction strategy.
Motivational interviewing involves bolstering an individual's motivation to change through the use of quiding principles, including: Avoiding discrepancy. Precontemplation. Rolling with resistance. Maintenance.
Rolling with resistance. The guiding principles of motivational interviewing include expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. The stages in the Transtheoretical Model are precontemplation, contemplation, preparation, action, maintenance, and termination.
A healthy nine-year-old male with no chronic medical issues is being seen for an initial psychiatric evaluation. His parents report issues related to his not listening at home, not following directions, and forgetting things. The parents further report that the patient's first-grade teacher has concerns related to distractibility, staying on task, and disruptive behaviors in class. The most appropriate next step is to: © Educate family and patient about behavior-management strategies. © Initiate a referral for individual and family psychotherapy. © Prescribe a non-stimulant medication for the patient. © Send the Vanderbilt ADHD Diagnostic Rating Scale home for parents and teacher to complete
Send the Vanderbilt ADHD Diagnostic Rating Scale home for parents and teacher to complete The patient could have attention deficit hyperactivity disorder (ADHD). To make a diagnosis, the psychiatric- mental health nurse practitioner (PMHNP) must ensure that the DSM-5 criteria are met, including documented symptoms and impairment in multiple settings (social, academic, occupational). The PMHNP must gather information from parents, teachers, school staff, and mental health clinicians involved in the child's care and rule out any alternative causes of the behavioral issues.
The psychiatric-mental health nurse practitioner (PMHNP) tells a patient, "As we have explored your feelings and thoughts, it seems as if you aren't sure who you are anymore, or what you are becoming. It appears that your identity is shifting, and this feels scary to you." The interview technique the PMHNP is using is: © Summarizing. © Reflecting. © Clarifying. © Reinforcing,
Summarizing. Summarizing is a therapeutic communication technique that recaps main points for clarification and modification. Reflection shows that the provider has listened and is interested. Clarification ensures the correct interoretation of information. while reinforcements express ongoing provider interest.
Which of these is a formal thought disorder? © Tangentiality © Thought broadcasting © Thought insertion © Thought withdrawal
Tangentiality A formal thought disorder is a disorder characterized by disruption in speech due to disorganized thoughts, typically linked to psychosis. Tangentiality, a type of formal thought disorder, involves the provision of excessive, irrelevant details that prevent the patient from reaching the conversation's point. Thought insertion, withdrawal, and broadcasting are Schneider's first-rank symptoms of schizophrenia.
Incorporating relapse prevention interventions into the plan of care of a patient with a history of alcohol use disorder is known as: © Tertiary prevention © Primary prevention. © Secondary prevention. © Nonprevention.
Tertiary prevention Primary prevention aims to reduce or eliminate risk factors before disease onset lowering its incidence (e.g., vaccinations for infectious diseases). Secondary prevention occurs during a disease's latent stage, focusing on early identification through screening and interventions to prevent symptoms. Tertiary prevention is initiated once a disease is established, aiming to prevent disability, further morbidity, and mortality. Relapse prevention is a goal of tertiary prevention.
A screening tool that measures severity of symptoms and tracks changes in specific symptoms is: © The Mini-Mental State Examination (MMSE). © The Short Form 36 (SF-36). © The Behavior and Symptom Identification Scale (BASIS) © The CAGE questionnaire.
The Mini-Mental State Examination (MMSE). The MMSE is a screening tool that evaluates the severity and progression of specific symptoms. It assesses various cognitive functions, such as orientation, attention, memory, construction, and language. It is commonly used to screen for dementia and to monitor its progression over time. BASIS is used by patients to assess mental health status, the SF- 36 is another patient self- assessment tool focusing on a four-week timespan, and the CAGE questionnaire assists in the diagnosis of alcoholism.
Which of the following actions would not be advisable for divorced parents facilitating recovery for their children? - The divorced couple provides an age-appropriate truthful explanation for why they divorced - The divorced couple continue working to relate to the child despite the child's anger. - The divorced couple shows consistent behavior toward the child. - The divorced couple avoids arguing with one another.
The divorced couple provides an age-appropriate truthful explanation for why they divorced Divorce recovery facilitation for children should not necessarily include an explanation for why the parents divorced, particularly if the circumstances are damaging or if the main cause is the behavior or actions of one of the parents (e.g., infidelity, sexual orientation, illicit drug use). This is true even if the explanation is framed in an age-appropriate manner.
A psychiatric-mental health nurse practitioner (PMHNP) is working with a young patient recently diagnosed with bipolar disorder, and is using a recovery model. On what should the PMHNP focus the interactions? © Managing the side effects of the medications © Assisting the patient in finding gainful employment © The patient's feelings, experience, and what they want to achieve © Psychoeducation about the patient's disease process
The patient's feelings, experience, and what they want to achieve The PMHNP's role in recovery is to assist a patient in rebuilding in personal, social, and spiritual domains, along with gauging how the individual is feeling, what they are experiencing, and what they want.
Dementia screening for the general population is not recommended because: © This service is unfocused for the target condition: The relative lack of sensitivity and specificity of dementia screening measures does not warrant widespread use. © This service causes net harm: Time and effort involved in screening detract from higher-priority preventive health measures in the general population. © This service has an unknown balance of benefit and harm: Current treatments have limited effectiveness in modifying instrumental activities of daily living. © This service yields a high number of false positives: The screening measures can produce misleading or inaccurate results
This service has an unknown balance of benefit and harm: Current treatments have limited effectiveness in modifying instrumental activities of daily living. Dementia screening is not indicated for the general population because the target condition is largely prevalent in the older adult. The balance of benefit and harm in the general population is unknown,.
A patient who does not leave home without a head covering states that they always wear something on their head because they do not want anyone to hear their thoughts. This type of delusion is referred to as: © Thought withdrawal. © Thought insertion. © Thought echo. © Thought broadcasting.
Thought broadcasting. Thought broadcasting is the delusion that one's thoughts are projected and received by others. Thought insertion is the belief that thoughts are placed in the mind from outside. Thought withdrawal is the belief that thoughts are being taken away from the person against their will. Thought echo is a hallucination that one's own thoughts are audible.
In the standard psychiatric evaluation, which section documents the appraisal of the patient's suicidal ideation, intent, plan, method, and access to means of implementing the plan? © Judgment section © Thought process section © Diagnosis section © Thought content section
Thought content section Suicidal ideation, intent, plan, method, and access are documented in the Mental Status Exam under Thought Content, which refers to the specific ideas, beliefs, or themes on which a person focuses. This section helps clinicians identifv suicidal plans or intent. The Thought Process section pertains to how a person thinks, while the Judgment section assesses their ability to make sound decisions based on the situation. The Diagnosis section is where a disease or condition is identified.
A 78-year-old cattleman referred for treatment of refractory depression by his primary care provider (PCP) reports continued thoughts of failure; lack of purpose in life; and lack of interest in ranching, fishing, hunting, and family ever since he lost his driver's license due to DUI six months ago. The priority assessment area is: © Thoughts of self-harm, plan, intent, access. © Sleep patterns (early-middle-late awakening), sleep hygiene. © Prior and current medications, dose, clinical response, side effects. © Extent of alcohol use and motivation to reduce to safe levels.
Thoughts of self-harm, plan, intent, access. Evaluating suicide risk and ensuring safety are of greatest priority, particularly in an elderly man who has multiple risk factors for suicide, including gender, age, loss, embarrassment to self and family (the DUI), access to guns, and alcohol use. The other areas need to be included in the assessment as well; however, suicide risk and safety is the priority area.
To help evaluate the functional status of a 68-year-old patient who has depression, the Instrumental Activities of Daily Living Scale includes: Using the toilet. Filing taxes. Using a telephone. Bathing
Using a telephone. Instrumental activities of daily living (IADLs) include actions that facilitate or enhance the performance of ADs (e.g., shopping, using the telephone, using transportation).
When conducting an initial abuse assessment screening in private where child, adult partner, or older adult abuse is suspected, the most appropriate initial abuse screening question is: © Within the past year, has anyone ever forced you to do something by threatening you with a gun? © Within the past year, has anyone ever threatened to kill you? © Within the past year, have you been hit, slapped, kicked or otherwise physically hurt by someone? © Within the past year, have you ever threatened or tried to commit suicide to escape the abuse?
Within the past year, have you been hit, slapped, kicked or otherwise physically hurt by someone? This response is one of four items on a standardized abuse assessment screen. If a positive response occurs, a danger assessment may follow using the other items.
The assessment tool that uses the question "Have you ever felt you should cut down on our drinking?" is: • The Drug Abuse Screening Test (DAST). • The CAGE questionnaire. • The Michigan Alcohol Screening Test (MAST) • The Alcohol Use Disorders Identification Test (AUDIT)
•The CAGE questionnaire. This is the first question in the CAGE questionnaire, which assesses alcohol use.
