*Domain 3 Questions Flashcards
A Psychiatric Mental Health Nurse Practitioner (PHNP) working in a community mental health clinic is assessing a 25-year-old patient with a history of bipolar disorder who presents with manic symptoms, including increased energy, decreased need for sleep, racing thoughts, and impulsivity. The patient is not currently taking any medication for their condition. The PMHNP confirms the diagnosis of acute mania. What is the most appropriate initial intervention of the PMHNP?
A. Initiate Lithium therapy immediately
B. Refer the patient to a psychotherapist for cognitive-behavioral therapy (CBT),
C. Prescribe Fluoxetine.
D. Prescribe a low-dose antipsychotic medication like Olanzapine (Zyprexa)
D. Prescribe a low-dose antipsychotic medication like Olanzapine (Zyprexa)
This option is generally considered the most appropriate initial intervention for a patient with acute mania.
Antipsychotic medications like Olanzapine can help rapidly reduce the severity of manic symptoms, such as impulsivity, racing thoughts, and agitation. They can provide quick relief and help the patient regain some stability. However, it’s essential to monitor for potential side effects and adjust the medication as needed.
Initiate Lithium therapy immediately. Lithium is a mood-stabilizing medication commonly used to treat bipolar disorder, particularly for managing manic episodes. It can help stabilize mood and reduce the severity of manic symptoms. However, initiating Lithium therapy immediately may not be the best option as it typically takes some time for Lithium to reach therapeutic levels in the blood. Additionally, the patient’s renal function and overall health should be assessed before starting Lithium, as it requires close monitoring and can have potential side effects.
*A 34-year-old female patient with a history of major depressive disorder (MDD) presents to your psychiatric clinic. She has been on a stable dose of a selective serotonin reuptake inhibitor (SSRI) for the past 6 months and reports an improvement in mood and functioning. However, in the last two weeks, she has been experiencing increased sadness, insomnia, and difficulty concentrating. She has no history of bipolar disorder or substance use disorder. Physical examination and laboratory tests are unremarkable. Which of the following is the most appropriate initial action for the PMHNP?
* A. Increase the dose of the current SSRI.
* B. Switch to a different class of antidepressant.
* C. Add alow-dose atypical antipsychotic.
* D. Assess for potential psychosocial stressors.
D. Assess for potential psychosocial stressors.
The most appropriate initial action in this case is to assess for potential psychosocial stressors. While the patient denies any recent stressors, it is essential to explore this further, as psychosocial factors can contribute to the worsening of depressive symptoms. It is crucial to rule out any underlying stressors before making medication changes.
Increasing the dose of the current SSRI should be considered if there is a partial response to treatment, but in this case, the patient’s symptoms are worsening despite being on a stable dose. This option is not the most appropriate initial action.
*You are a psychiatric mental health nurse practitioner (PMHNP) working in a pain management clinic. Your patient, Tom, a 45-year-old man, has been prescribed oxycodone (OxyContin, 10 mg q12h) for chronic lower back pain for the past five years. Tom reports that he used to feel relief with one tablet, but now he requires three tablets to achieve the same level of pain relief. What process might explain Tom’s increased need for opioids?
* A. Kindling
* B. Addiction
* c. Tolerance
* D. Potency
- c. Tolerance
*You are a psychiatric mental health nurse practitioner (PMHNP) working in a pediatric clinic.
Sarah, a 7-year-old girl, has been referred to you due to concerns about her behavior at school and home. Her teacher reports that Sarah frequently interrupts others, has difficulty staying seated, and often seems forgetful and disorganized. Her parents also note that she is often restless, struggles to follow instructions, and frequently loses her belongings. In the assessment process for ADHD, which of the following option is an important consideration?
* A. Symptoms occurring only in one setting (e.g., school) do not support an ADHD diagnosis.
* B. Symptoms of inattention are typically not seen in children with ADHD.
* C. ADHD can be definitively diagnosed through a single behavioral assessment.
* D. The presence of symptoms in multiple settings (e.g., home and school) is an essential criterion.
D. The presence of symptoms in multiple settings (e.g., home and school) is an essential criterion.
You are a psychiatric mental health nurse practitioner (PMHNP) working in an outpatient pediatric clinic. Sarah’s parents have brought her for an evaluation due to concerns about her behavior. Sarah is an 8-year-old girl who frequently exhibits symptoms such as difficulty paying attention, forgetfulness, impulsivity, and frequent restlessness. You are considering various diagnoses. Which diagnosis should you prioritize based on the provided information?
- A. Attention-Deficit/Hyperactivity Disorder (ADHD)
- B. Conduct Disorder
- C. Generalized Anxiety Disorder (GAD)
- D. Autism Spectrum Disorder (ASD)
A. Attention-Deficit/Hyperactivity Disorder (ADHD)
*You are a psychiatric mental health nurse practitioner (PMHNP) conducting an initial evaluation of a 9-year-old boy named Alex. He is brought in by his parents, who express concerns about his behavior and academic performance. Alex’s parents report that he often has difficulty paying attention, frequently interrupts others during conversations, struggles to complete school assignments, and seems to act without thinking. Based on your assessment, which of the following diagnoses should be considered as the most likely initial evaluation for Alex?
- A. Oppositional Defiant Disorder (ODD)
- B. Anxiety Disorder
- C. Attention-Deficit/Hyperactivity Disorder (ADHD)
- D. Autism Spectrum Disorder (ASD)
C. Attention-Deficit/Hyperactivity Disorder (ADHD)
*You are a psychiatric mental health nurse practitioner (PMHNP) conducting an assessment on a
10-year-old child named Alex, who has been exhibiting symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). You are considering the neurological factors associated with ADHD. Which of the following brain areas or abnormalities is most closely linked to the pathophysiology of ADHD?
- A. Hypoactivation of the prefrontal cortex
- B. Enlarged hippocampus
- C. Overactivity in the amygdala
- D. Normal functioning of the basal ganglia
A. Hypoactivation of the prefrontal cortex
Correct Answer: A. Hypoactivation of the prefrontal cortex ADHD has been associated with hypoactivation (reduced activity) in the prefrontal cortex, a brain region responsible for executive functions such as attention, impulse control, and working memory. This reduced activation contributes to the symptoms of inattention and impulsivity seen in ADHD.
*You are a psychiatric mental health nurse practitioner (PMHNP) working in a child and adolescent mental health clinic. Sarah, a 13-year-old girl, has recently been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Her parents are interested in exploring pharmacological treatment options. Based on current guidelines and best practices, which of the following medication options should you recommend for Sarah’s ADHD?
- Methylphenidate (Ritalin) XR, an extended-release stimulant
- Lorazepam (Ativan), an anxiolytic medication
- Fluoxetine (Prozac), a selective serotonin reuptake inhibitor (SSRI)
- Amitriptyline (Elavil), a tricyclic antidepressant (TCA)
- Methylphenidate (Ritalin) XR, an extended-release stimulant
*You are a psychiatric mental health nurse practitioner (PMHNP) in a pediatric clinic. You are assessing a 9-year-old boy, Liam, who has recently been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Liam’s parents are concerned about his frequent motor and vocal tics. Considering his tic disorder and ADHD, which medication is the most appropriate choice?
A. Methylphenidate (Ritalin)
B. Atomoxetine (Strattera)
C. Guanfacine (Intuniv)
D. Bupropion (Wellbutrin)
C. Guanfacine (Intuniv)
Correct Answer: C. Guanfacine (Intuniv) Guanfacine is an alpha-2 adrenergic agonist that is sometimes preferred in cases of ADHD with comorbid tics or tic disorders. It can effectively manage ADHD symptoms without exacerbating tics and may even help reduce tic severity. Guanfacine is a suitable choice for Liam considering his frequent tics, as it addresses both ADHD and tic symptoms.
A. Methylphenidate (Ritalin): Methylphenidate is a first-line stimulant medication for ADHD, but it may exacerbate tics in individuals with pre-existing tic disorders like Tourette syndrome. Given Liam’s frequent motor and vocal tics, methylphenidate is not the most appropriate choice, as it could potentially worsen his tic symptoms. This option is less suitable in the presence of tics and is incorrect.
B. Atomoxetine (Strattera): Atomoxetine is a non-stimulant medication approved for ADHD. While it doesn’t exacerbate tics like stimulants, it may not be the first choice when tics are present due to alternative options available. Atomoxetine targets norepinephrine and may be considered if guanfacine is ineffective or not tolerated. However, given Liam’s tic disorder, there are more suitable options. This option is less relevant for tics and is incorrect.
*You are a psychiatric mental health nurse practitioner (PMHNP) working in a child and adolescent mental health clinic. You are evaluating an 8-year-old boy, Owen, who has been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Owen’s parents report that he has recently developed noticeable motor and vocal tics, which are causing distress. They are seeking guidance on pharmacological treatment options for their son. Given Owen’s tics, which of the following medications is a preferred choice for the treatment of ADHD in this case?
- A. Methylphenidate (Ritalin)
- B. Atomoxetine (Strattera)
- C. Clonidine (Kapvay)
- D. Lisdexamfetamine (Vyvanse)
- C. Clonidine (Kapvay)
Correct Answer: C. Clonidine (Kapvay) Clonidine is an alpha-2 adrenergic agonist medication that has been used to manage both ADHD and tics, especially in cases where they co-occur. Clonidine helps with impulse control and can reduce tic frequency and severity. It is a preferred choice in individuals with ADHD and comorbid tics due to its potential to address both conditions. This option is correct and preferred in this scenario.
A. Methylphenidate (Ritalin): Methylphenidate is a stimulant medication used to treat ADHD. However, in individuals with comorbid tics, stimulants like methylphenidate may exacerbate tic symptoms. Therefore, it is not the preferred choice in this case, given Owen’s tics. This option is less relevant due to the presence of tics and is incorrect.
B. Atomoxetine (Strattera): Atomoxetine is a non-stimulant medication approved for ADHD treatment. It is generally considered a suitable option for individuals with ADHD who have comorbid conditions like tics, as it does not worsen tic symptoms and has a different mechanism of action. Atomoxetine increases norepinephrine levels in the brain. This option is a reasonable choice but not the preferred one in this scenario.
*You are a psychiatric mental health nurse practitioner (PMHNP) working in an addiction treatment center. You are assessing a 19-year-old college student, Alex, who has been referred for potential substance abuse. Alex’s friends and family have expressed concerns about his behavior. During the assessment, you are specifically looking for signs of stimulant abuse.
Which of the following signs and symptoms are indicative of stimulant abuse?
A. Weight gain and increased appetite.
B. Prolonged periods of excessive sleep.
C. Agitation, restlessness, and increased energy levels.
D. Slurred speech and slowed reaction times.
C. Agitation, restlessness, and increased energy levels.
*You are a psychiatric mental health nurse practitioner (PMHNP) working in a pediatric clinic. You are assessing a 9-year-old boy, Liam, who has recently been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Liam’s parents are interested in non-pharmacological approaches to help manage their son’s ADHD symptoms. Which of the following non-pharmacological interventions is a recommended strategy for the management of ADHD in Liam?
- A. Cognitive-Behavioral Therapy (CBT)
- B. High-dose vitamin supplementation
- C. Increased screen time and video games
- D. Avoiding any structured routines
- A. Cognitive-Behavioral Therapy (CBT)
Correct answer. A. Cognitive-Behavioral Therapy (CBT): CBT is a recommended non-pharmacological intervention for managing ADHD symptoms in children. It focuses on teaching individuals with ADHD strategies to improve executive functioning, impulse control, time management, and organizational skills. CBT can help children like Liam develop adaptive behaviors and coping strategies to manage their ADHD
symptoms effectively.
*You are a psychiatric mental health nurse practitioner (PMHNP) working in a pediatric clinic. You are assessing a 7-year-old girl, Mia, who has recently been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Mia’s parents are interested in non-pharmacological interventions for their daughter. Which of the following non-pharmacological management strategies is the most appropriate initial step for the PMHNP?
- A. Behavioral therapy focusing on symptom reduction.
- B. Dietary modifications, including eliminating artificial food colorings.
- C. Vigorous physical exercise for at least 30 minutes daily.
- D. Psychoeducation for Mia and her parents.
- D. Psychoeducation for Mia and her parents.
Correct Answer: D. Psychoeducation for Mia and her parents. Psychoeducation is an important first step in ADHD management. It empowers both the child and the parents with knowledge about the condition and available treatment options. With a solid understanding of ADHD, Mia’s parents can make informed decisions about her care, including the potential use of behavioral therapy, dietary modifications, and exercise as complementary strategies. Psychoeducation provides a foundation for a collaborative and holistic approach to managing ADHD.
A. Behavioral therapy focusing on symptom reduction: Behavioral therapy is a valuable component of ADHD management. However, the initial step for Mia should involve psychoeducation. This option is less appropriate because starting with behavioral therapy without adequate understanding and education about
ADHD may not yield the best results.
*You are a psychiatric mental health nurse practitioner (PMHNP) working in an outpatient mental health clinic. You are evaluating a 26-year-old patient, Mark, who presents with a complex history of emotional instability, self-harming behaviors, and tumultuous relationships. Mark describes frequent mood swings, often triggered by minor stressors, and reports feelings of emptiness. He acknowledges recurrent thoughts of self-harm and suicide, particularly when he feels abandoned by loved ones. Mark also reveals impulsive behaviors, such as reckless driving and substance abuse. To establish a diagnosis, you must consider various possibilities. Which of the following diagnoses is the most likely and relevant for Mark’s clinical presentation?
- A. Major Depressive Disorder (MDD).
- B. Bipolar II Disorder.
- C. Generalized Anxiety Disorder (GAD).
- D. Borderline Personality Disorder (BPD).
- D. Borderline Personality Disorder (BPD).
*You are a psychiatric mental health nurse practitioner (PMHNP) working with a 32-year-old patient, Sarah, who has been diagnosed with borderline personality disorder (BPD). Sarah experiences emotional dysregulation, impulsive behaviors, self-harming tendencies, and interpersonal difficulties. As part of her treatment plan, you are considering non-pharmacological interventions. Which non-pharmacological management approach is most appropriate to address the core symptoms of BPD in Sarah?
- A. Electroconvulsive Therapy (ECT).
- B. Dialectical Behavior Therapy (DBT).
- C. Antipsychotic Medications.
- D. Inpatient Hospitalization.
- B. Dialectical Behavior Therapy (DBT).
Correct Answer: B. Dialectical Behavior Therapy (DBT). Dialectical Behavior Therapy (DBT) is the most appropriate non-pharmacological management approach for addressing the core symptoms of borderline personality disorder (BPD) in Sarah. DBT is a structured and evidence-based psychotherapy specifically designed for individuals with BPD. It focuses on teaching skills for emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. DBT has been shown to be effective in reducing self-harming behaviors, impulsive actions, and emotional dysregulation in individuals with BPD. This option is correct because it aligns with best practices for BPD treatment.
You are a psychiatric mental health nurse practitioner (PMHNP) working with a 29-year-old patient, Emily, who has been diagnosed with borderline personality disorder (BPD). In addition to her BPD symptoms, Emily presents severe mood swings, impulsivity, and recurrent episodes of depression. You are considering pharmacological interventions to manage her comorbid conditions. Which of the following pharmacological options will be most appropriate?
- A. Selective Serotonin Reuptake Inhibitors (SSRIs).
- B. Antipsychotic Medications.
- C. Benzodiazepines.
- D. Mood Stabilizers.
A. Selective Serotonin Reuptake Inhibitors (SSRIs).
Correct Answer: A. Selective Serotonin Reuptake Inhibitors (SSRIs). Selective Serotonin Reuptake Inhibitors (SSRIs) are the most appropriate pharmacological option for managing Emily’s comorbid major depressive episodes. SSRIs are effective in treating depressive symptoms and are commonly used in individuals with BPD who experience co-occurring depression. They are considered a first-line treatment for depression and can help improve Emily’s mood and overall functioning. However, the choice of medication should be made after a thorough assessment and consideration of potential side effects and individual response to treatment.
Read the question carefully! It describe BPD symtpoms NOT manic symptoms and depressive symptoms.
*You are a psychiatric mental health nurse practitioner (PMHNP) conducting an initial assessment on a 28-year-old patient, John, who has a history of repeated legal issues, a lack of remorse or empathy for others, and a pattern of manipulative and deceitful behaviors. John has a history of impulsive and aggressive acts, including physical altercations and reckless driving.
You suspect a personality disorder and need to consider potential diagnoses. Which of the following is the most likely diagnosis?
- A. Major Depressive Disorder (MDD).
- B. Social Anxiety Disorder (SAD).
- C. Antisocial Personality Disorder (ASP).
- D. Obsessive-Compulsive Disorder (OCD).
- C. Antisocial Personality Disorder (ASP).
*You are a psychiatric mental health nurse practitioner (PMHNP) working in an outpatient mental health clinic. You are conducting an assessment for a 35-year-old patient, Sarah, who presents with a longstanding pattern of social inhibition, feelings of inadequacy, and hypersensitivity to criticism or rejection. Sarah describes extreme discomfort in social situations, often avoiding them altogether due to fear of embarrassment. She has difficulty forming close relationships and prefers solitary activities. Which of the following diagnoses is the most likely diagnosis?
- A. Major Depressive Disorder (MDD).
- B. Social Anxiety Disorder (SAD).
- C. Bipolar II Disorder.
- D. Avoidant Personality Disorder (AVPD).
- D. Avoidant Personality Disorder (AVPD)
Correct Answer: D. Avoidant Personality Disorder (AVPD). Avoidant Personality Disorder (AVPD) is the most likely and relevant diagnosis for Sarah’s clinical presentation. It captures the core features of her social inhibition, hypersensitivity to criticism or rejection, discomfort in social situations, and strong desire for social acceptance. Individuals with AVPD often have a longstanding pattern of avoidance in social situations due to their fear of embarrassment or rejection. Sarah’s description of her difficulties in forming close relationships and her preference for solitary activities further supports the diagnosis of AVPD. Given the comprehensive match between Sarah’s symptoms and the criteria for AVPD, this option is the most appropriate diagnosis to consider and explore further.
B. Social Anxiety Disorder (SAD): Social Anxiety Disorder (SAD) involves intense fear and avoidance of social situations due to the fear of being negatively evaluated or judged by others. While there may be some overlap in symptoms between SAD and AVPD, individuals with AVPD often exhibit a more pervasive and longstanding pattern of social inhibition and avoidance that extends beyond the fear of negative evaluation.
AVPD is characterized by a deep-seated need for social acceptance and a fear of interpersonal rejection.
Given Sarah’s description of discomfort in social situations and her difficulty forming close relationships,
AVPD is a more suitable diagnosis than SAD. This option is less likely.
*You are a psychiatric mental health nurse practitioner (PMHNP) working in an outpatient mental health clinic. You are assessing a 35-year-old patient, Alex, who presents with a pervasive pattern of grandiosity, a need for admiration, and a lack of empathy for others. Alex frequently exaggerates his achievements, believes he is unique and deserves special treatment, and is preoccupied with fantasies of success, power, and beauty. He has a history of exploiting others for personal gain and has a sense of entitlement. Which of the following is the most likely diagnosis?
- A. Major Depressive Disorder (MDD).
- B. Bipolar I Disorder.
- C. Narcissistic Personality Disorder (NPD).
- D. Obsessive-Compulsive Disorder (OCD).
C. Narcissistic Personality Disorder (NPD).
Correct Answer: C. Narcissistic Personality Disorder (NPD). Narcissistic Personality Disorder (NPD) is the most likely and relevant diagnosis for Alex’s clinical presentation. It encompasses the core features of pervasive grandiosity, a need for admiration, lack of empathy, entitlement, and preoccupation with fantasies of success, power, and beauty, which are characteristic of NPD. Individuals with NPD often display a chronic and stable pattern of behaviors that reflect an exaggerated sense of self-importance and a disregard for the feelings and needs of others. Given Alex’s history and presentation, NPD is the most suitable diagnosis to consider and further evaluate.
*You are a psychiatric mental health nurse practitioner (PMHNP) working in an outpatient mental health clinic. You are assessing a 40-year-old patient, Sarah, who presents with a long history of emotional detachment, a preference for solitary activities, limited emotional expression, and few close relationships. Sarah describes a lifelong pattern of social disinterest and an inability to derive pleasure from social interactions. Which of the following is the most likely diagnosis?
- A. Major Depressive Disorder (MDD).
- B. Schizoid Personality Disorder (SPD).
- C. Generalized Anxiety Disorder (GAD).
- D. Bipolar II Disorder.
B. Schizoid Personality Disorder (SPD).
*You are a psychiatric mental health nurse practitioner (PMHNP) conducting an assessment of a
35-year-old patient, Alex, who presents with a history of eccentric behaviors, odd beliefs, and discomfort in social relationships. Alex describes experiencing magical thinking, unusual perceptual experiences, and having beliefs in special powers and supernatural phenomena.
Which of the following is the most likely diagnosis?
- A. Major Depressive Disorder (MDD).
- B. Schizotypal Personality Disorder (STPD).
- C. Generalized Anxiety Disorder (GAD).
- D. Obsessive-Compulsive Disorder (OCD).
- B. Schizotypal Personality Disorder (STPD).
Correct Answer: B. Schizotypal Personality Disorder (STPD). Schizotypal Personality Disorder (STPD) is the most likely and relevant diagnosis for Alex’s clinical presentation. It encompasses the core features of eccentric behaviors, odd beliefs, discomfort in social relationships, magical thinking, and unusual perceptual experiences, which are characteristic of STPD. Individuals with STPD often exhibit peculiar or eccentric beliefs and may experience ideas of reference or strange perceptual experiences. Alex’s history and presentation align comprehensively with the criteria for STPD, making it the most suitable diagnosis to consider and further evaluate.
*You are a psychiatric mental health nurse practitioner (PMHNP) working in an outpatient mental health clinic. You are assessing a 32-year-old patient, Alex, who presents with a history of eccentric behavior, odd beliefs, unusual perceptual experiences, and discomfort in social situations. Alex has a history of magical thinking, believes in superstitions, and has peculiar mannerisms and speech. Which of the following diagnoses is the most likely and relevant for Alex’s clinical presentation?
- A. Major Depressive Disorder (MDD).
- B. Schizophrenia.
- C. Schizotypal Personality Disorder (STPD).
- D. Generalized Anxiety Disorder (GAD).
C. Schizotypal Personality Disorder (STPD).
*You are a psychiatric mental health nurse practitioner (PMHNP) working in an outpatient mental health clinic. You are assessing a 40-year-old patient, Mark, who presents with a longstanding history of pervasive distrust and suspicion of others. Mark is highly sensitive to perceived slights, frequently questions the loyalty of friends and acquaintances, and is often preoccupied with doubts about the intentions of others. Which of the following diagnoses is the most likely diagnosis?
- A. Borderline Personality Disorder (BPD).
- B. Schizoid Personality Disorder (SPD).
- C. Paranoid Personality Disorder (PPD).
- D. Generalized Anxiety Disorder (GAD).
C. Paranoid Personality Disorder (PPD).
*You are a psychiatric mental health nurse practitioner (PMHNP) conducting an assessment of a
38-year-old patient, Lisa, who presents with a longstanding pattern of preoccupation with orderliness, perfectionism, and control. Lisa is highly focused on details, often to the point of neglecting the broader picture. She is excessively devoted to work and productivity, to the extent that leisure and interpersonal relationships are neglected. Which of the following is the most likely diagnosis?
- A. Borderline Personality Disorder (BPD).
- B. Antisocial Personality Disorder (ASP).
- C. Histrionic Personality Disorder (HPD).
- D. Obsessive-Compulsive Personality Disorder (OCPD).
D. Obsessive-Compulsive Personality Disorder (OCPD).
*You are a psychiatric mental health nurse practitioner (PHNP) conducting an assessment of a
29-year-old patient, Emily, who presents with a pervasive and long-standing pattern of submissive and clinging behavior, a fear of separation from loved ones, and a strong need to be taken care of by others. Emily has difficulty making decisions without excessive advice and reassurance from others, and she often goes to great lengths to please others to avoid abandonment. Which of the following is the most likely diagnosis?
- A. Borderline Personality Disorder (BPD).
- B. Narcisistic Personality Disorder (NPD).
- C. Dependent Personality Disorder (DPD).
- D. Schizoid Personality Disorder (SPD).
C. Dependent Personality Disorder (DPD).
*You are a psychiatric mental health nurse practitioner (PMHNP) conducting an assessment of a
4-year-old child, Ethan, who presents with certain developmental and behavioral concerns.
Ethan’s parents report that he has difficulty with social interactions, often avoids eye contact, and appears indifferent to others’ emotions or interests. He has a strong preference for repetitive activities and routines, gets upset with changes in his environment, and has delayed speech and language development. Which of the following is the most likely diagnosis?
- A. Attention-Deficit/Hyperactivity Disorder (ADHD).
- B. Oppositional Defiant Disorder (ODD).
- C. Autism Spectrum Disorder (ASD).
- D. Specific Learning Disorder (SLD).
C. Autism Spectrum Disorder (ASD).
*You are a psychiatric mental health nurse practitioner (PMHNP) conducting an assessment of a
4-year-old child, Ethan, who has been brought in by his parents due to concerns about his social interactions, communication difficulties, and repetitive behaviors. Ethan often avoids eye contact, has difficulty with language development, and prefers playing alone with specific toys or objects. Which of the following is the most likely diagnosis?
- A. Attention-Deficit/Hyperactivity Disorder (ADHD).
- B. Oppositional Defiant Disorder (ODD).
- C. Autism Spectrum Disorder (ASD).
- D. Specific Language Impairment (SLI).
C. Autism Spectrum Disorder (ASD).
*You are a psychiatric mental health nurse practitioner (PMHNP) working in a pediatric clinic. You are assessing a 3-year-old child, Sarah, whose parents have expressed concerns about her behavior. Sarah has a consistent habit of lining up her toys in precise rows and patterns, and she becomes distressed when others disrupt these arrangements. Her parents report that she has difficulty with social interactions and communication. Which of the following is the most likely diagnosis?
- A. Attention-Deficit/Hyperactivity Disorder (ADHD).
- B. Obsessive-Compulsive Disorder (OCD).
- C. Autism Spectrum Disorder (ASD).
- D. Developmental Coordination Disorder (DCD).
C. Autism Spectrum Disorder (ASD).
*You are a psychiatric mental health nurse practitioner (PMHNP) working with a 5-year-old child, Ava, who has been diagnosed with Autism Spectrum Disorder (ASD). Ava’s parents are interested in nopharmacological interventions to help improve her social and communication skills. Which of the following nonpharmacological interventions is commonly recommended for children with Autism Spectrum Disorder (ASD)?
- A. Cognitive-Behavioral Therapy (CBT).
- B. Applied Behavior Analysis (ABA) therapy.
- C. Electroconvulsive Therapy (ECT).
- D. Psychodynamic Therapy.
B. Applied Behavior Analysis (ABA) therapy.
Correct Answer: B. Applied Behavior Analysis (ABA) therapy. Applied Behavior Analysis (ABA) therapy is commonly recommended and considered a highly effective nonpharmacological intervention for children with Autism Spectrum Disorder (ASD). ABA therapy is structured, evidence-based, and focuses on improving social and communication skills, reducing challenging behaviors, and enhancing overall functioning in individuals with ASD. It is a targeted and systematic approach that utilizes positive reinforcement and behavioral strategies to achieve specific goals related to social and communication deficits commonly seen in ASD. Therefore, ABA therapy is the most suitable choice for nonpharmacological management of Ava’s ASD-related challenges.
*You are a psychiatric mental health nurse practitioner (PMHNP) working with the parents of a 8-year-old child, Max, who has been diagnosed with Autism Spectrum Disorder (ASD) and comorbid Attention-Deficit/Hyperactivity Disorder (ADHD). Max’s parents are inquiring about how stimulant medications can potentially help improve his symptoms. Which of the following mechanisms best describes how stimulant medications may benefit individuals like Max with comorbid ASD and ADHD?
- A. Stimulant medications primarily target the core symptoms of Autism Spectrum Disorder (ASD) by enhancing social cognition and empathy.
- B. Stimulant medications modulate the release and reuptake of neurotransmitters, such as dopamine and norepinephrine, which play a role in attention, focus, and impulse control.
- C. Stimulant medications directly affect the functioning of mirror neurons in the brain, leading to
improved imitation and social interaction skills. - D. Stimulant medications promote the development of adaptive social behaviors and reduce sensory sensitivities in individuals with ASD.
B. Stimulant medications modulate the release and reuptake of neurotransmitters, such as dopamine and norepinephrine, which play a role in attention, focus, and impulse control.
*You are a psychiatric mental health nurse practitioner (PMHNP) assessing a 10-year-old child, Emily, who presents with severe temper outbursts, irritability, and mood fluctuations. Emily’s parents are concerned about her emotional and behavioral struggles. As part of your evaluation, you consider various diagnostic possibilities. Which of the following is the most likely diagnosis?
- A. Generalized Anxiety Disorder (GAD)
- B. Oppositional Defiant Disorder (ODD)
- C. Attention-Deficit/Hyperactivity Disorder (ADHD)
- D. Disruptive Mood Dysregulation Disorder (DMDD)
- D. Disruptive Mood Dysregulation Disorder (DMDD)
*A PMHNP is reviewing the case of a 22-year-old female patient presenting with recurrent behavioral outbursts over the last six months. These episodes are characterized by verbal aggression and three instances of damaging property, which appear to be disproportionate to any psychosocial stressors. The patient feels a sense of tension before the outburst and relief afterward. No consistent mood changes are noted between episodes, and the patient has no significant history of unstable relationships or self-image issues. There is no evidence of substance use or a general medical condition that could explain these behaviors. What is the most likely diagnosis?
- A. Intermittent Explosive Disorder (IED)
- B. Borderline Personality Disorder (BPD)
- C. Conduct Disorder
- D. Bipolar Disorder
A. Intermittent Explosive Disorder (IED)
*A 38-year-old female patient presents with a two-week history of persistent low mood, loss of interest in previously enjoyed activities, significant weight loss, and difficulty concentrating.
She also reports feelings of worthlessness and recurrent thoughts of death. Which of the following psychiatric diagnoses is MOST likely in this case?
- A. Generalized Anxiety Disorder (GAD)
- B. Bipolar Disorder, Depressed Phase
- C. Major Depressive Disorder (MDD)
- D. Borderline Personality Disorder (BPD)
C. Major Depressive Disorder (MDD)
*A 72-year-old female patient presents to your psychiatric clinic with complaints of memory loss, confusion, and difficulty concentrating. She reports that these symptoms have been progressively worsening over the past few months. Her family members are concerned about her cognitive decline and fear she may have dementia. Upon further evaluation, you observe the following:
- The patient appears anxious and emotionally distressed.
- She seems preoccupied with her memory problems and frequently mentions her fear of developing Alzheimer’s disease.
- She is able to provide a detailed account of her cognitive deficits and is concerned about her ability to manage her daily activities.
- The patient’s cognitive impairment seems to fluctuate during the interview.
- Her family reports that the symptoms began shortly after she experienced a stressful life event.
Which of the following is the most likely diagnosis for this patient’s presentation?
- A. Alzheimer’s Disease
- B. Vascular Dementia
- C. Pseudodementia
- D. Frontotemporal Dementia
C. Pseudodementia
Correct answer. C. Pseudodementia. Pseudodementia is often associated with depressive symptoms, and patients may have cognitive deficits that mimic dementia. Key features in this case include the patient’s emotional distress, preoccupation with memory problems, and cognitive impairment that fluctuates.
Pseudodementia is more likely to occur in the context of a major depressive episode, and it often improves with treatment of the underlying depression.
*A 65-year-old male with a history of recurrent major depressive episodes presents to your clinic.
His wife is concerned about his recent memory problems. During the assessment, whenever asked about specific details regarding his memory issues, he frequently responds with “I don’t know” and appears distressed. He also mentions feeling hopeless about his life. His physical examination and basic cognitive screening are within normal limits. What is the most likely diagnosis?
- A. Alzheimer’s Dementia
- B. Vascular Dementia
- C. Pseudodementia
- D. Frontotemporal Dementia
C. Pseudodementia
Pseudodementia, associated with depression, often presents with the patient showing more concern about their cognitive deficits than what is observed clinically. The use of “I don’t know” might reflect a lack of effort or distress related to depression, rather than true cognitive impairment. The normal physical examination and his history of depression strongly point towards pseudodementia.
A 45-year-old male patient has recently been diagnosed with major depressive disorder (MDD).
The patient has no significant medical history and is not currently taking any medication.
Considering his profile and the need for an antidepressant, which of the following medications would be most appropriate to initiate treatment?
A. Fluoxetine
B. Amitriptyline
C. Phenelzine
D. Bupropion
A. Fluoxetine
A 30-year-old female patient with a history of major depressive disorder (MDD) presents with recurrent episodes of depression. She has previously been treated with an SSRI (Selective Serotonin Reuptake Inhibitor) and experienced sexual dysfunction as a side effect. She reports experiencing low energy, weight gain, and significant fatigue. Which of the following will be the most appropriate medication to prescribe?
- A. Wellbutrin
- B. Sertraline
- C. Duloxetine
- D. Clomipramine
A. Wellbutrin
Correct answer. A. Wellbutrin is an NDRI that works primarily on the norepinephrine and dopamine systems. It is known for its activating properties and lower risk of causing sexual dysfunction compared to SSRIs. Wellbutrin is often considered in cases where patients with MDD experience low energy, weight gain, and significant fatigue, as it can help alleviate these symptoms and improve motivation and energy levels.
*A 45-year-old male patient with a history of major depressive disorder (MDD) presents to your psychiatric clinic. He reports experiencing persistent depressive symptoms, including low mood, and anxiety. The patient reports a history of chronic neuropathic pain. Which of the following will be the most appropriate class of medication to prescribe?
- A. SNRI (Serotonin-Norepinephrine Reuptake Inhibitor)
- B. NDRI (Norepinephrine-Dopamine Reuptake Inhibitor)
O C. SSRI (Selective Serotonin Reuptake Inhibitor) - D. MAOI (Monoamine Oxidase Inhibitor)
A. SNRI (Serotonin-Norepinephrine Reuptake Inhibitor)
Correct answer. A. SNRI (Serotonin-Norepinephrine Reuptake Inhibitor). Neuropathic pain often involves alterations in both the serotonin and norepinephrine pathways. SNRIs like Duloxetine (Cymbalta) or Venlafaxine (Effexor) are well-suited for individuals with MDD who also experience neuropathic pain. These medications not only target the serotonin pathway, addressing depressive symptoms and anxiety, but also the norepinephrine pathway, which can help alleviate neuropathic pain. This dual mechanism of action makes SNRIs a suitable choice for this patient, addressing both his mood disorder and chronic pain.
A 34-year-old male patient with a history of major depressive disorder (MDD) presents to your psychiatric clinic for a medication evaluation. A PMHNP is considering prescribing Wellbutrin (bupropion) as part of his treatment plan. Which of the following contraindications should be carefully assessed before prescribing Wellbutrin?
- A. A history of seizure disorder
- B. A history of insomnia
- C. A history of nicotine dependence
- D. A history of seasonal affective disorder (SAD)
A. A history of seizure disorder
Correct answer. A. A history of seizure disorder is a significant contraindication to prescribing Wellbutrin (bupropion). Wellbutrin lowers the seizure threshold, and individuals with a history of seizures are at increased risk of experiencing seizures when taking this medication. Therefore, it is crucial to assess a history of seizure disorder before considering Wellbutrin as a treatment option.
*A 35-year-old female patient with a history of major depressive disorder (MDD) presents for a medication evaluation. You are considering prescribing Wellbutrin (bupropion) as part of her treatment plan. Which of the following contraindications should be carefully considered before prescribing Wellbutrin?
- A. A family history of anxiety disorders
- B. A history of binge eating disorder
- C. A recent upper respiratory tract infection
- D. A history of insomnia
B. A history of binge eating disorder
Correct answer. B. A history of binge eating disorder is a contraindication to prescribing Wellbutrin (bupropion). Wellbutrin has been associated with a risk of seizures, especially at higher doses. Patients with eating disorders, particularly those with a history of binging, may be at increased risk for electrolyte imbalances and dehydration, which can lower the seizure threshold. Therefore, caution should be exercised, and alternative treatment options should be considered in this population.
Here are some contraindications to Wellbutrin:
Seizure Disorders: Wellbutrin lowers the seizure threshold, increasing the risk of seizures. Therefore, it is contraindicated in individuals with a history of seizures, including epilepsy. Patients with a history of seizures should be evaluated carefully, and alternative antidepressant options should be considered.
History of Bulimia or Anorexia Nervosa: Wellbutrin may increase the risk of seizures in individuals with eating disorders, particularly those with a history of bulimia or anorexia nervosa. This is another situation where alternative antidepressant choices should be explored.
Current Alcohol or Benzodiazepine Withdrawal: Wellbutrin may increase the risk of seizures, and its use is contraindicated in individuals undergoing alcohol or benzodiazepine withdrawal, as withdrawal itself can lower the seizure threshold.
*A 42-year-old male patient diagnosed with generalized anxiety disorder (GAD) is prescribed an
SSRI (Selective Serotonin Reuptake Inhibitor) for treatment. During the medication education session, the PMHNP discusses potential side effects. Which of the following common side effects of SSRIs should the PMHNP emphasize as relevant to this patient?
- A. Bradycardia and hypotension
- B. Weight loss and decreased appetite
*C. Muscle stiffness and tremors - D. Sexual dysfunction and nausea
D. Sexual dysfunction and nausea
