PMHNP Review Questions Flashcards
Sam is being treated for panic disorder with agoraphobia. He is currently prescribed paroxetine (Paxil CR) 37.5mg qd & clonazepam (Klonopin) 0.5mg qd He has been on clonazepam for 2 years and admits to needing 4 tablets to do what 1 tablet used to do. This is an example of:
a. Kindling
b. Addiction
c. Tolerance
d. Potency
C. Tolerance
A mother brings in her 7y/o son for a psychiatric follow-up with the PMHNP. This is the fourth visit the PMHNP has had with the client, his mother and 7mo sister. You notice that she has had a decrease in head growth, along with stereotypic motions of the hands, often licking and slapping. She has also lost her language skills. What medical condition do you suspect Renee has developed?
a. Autism spectrum disorder
b. Rett syndrome
c. Selective mutism
d. Tourette’s disorder
b. Rett syndrome
Diagnosing Depression Mnemonic S I G E C A P S
Sleep disturbance Interest reduced Guilt & self-blame Energy loss & fatigue Concentration problem Appetite changes Psychomotor changes Suicidal thoughts.
Which characteristic of fluoxetine (Prozac) provides the greatest degree of safety for patients who have severe depression?
a. Greater efficacy the TCAs
b. less potential for drug interaction
c. less potential for injury with intentional overdose
d. less potential for suicidal thinking
c. less potential for injury with intentional overdose
During patient education about sertraline (Zoloft), an adult PMHNP focuses upon the potential side effects of:
a. agranulocytosis
b. hypernatremia
c. sexual dysfunction
d. weight loss
c. sexual dysfunction
and severe GI upset
A 72 y/o female is brought in by her husband with increasing forgetfulness, decreased activity and decreased appetite for 2 months. She has a history of htn and is being treated with lisinopril. The exam is normal, and the mini-mental status exam provides a score of 24 but she declines to answer some questions and needs to be urged to participate in the assessment. What is the most likely diagnosis.
a. Alzheimer disease
b. vascular dementia
c. depression
d. medication toxicity
c. depression
A 23 y/o woman is brought into the ER after attempting suicide by cutting her wrists. Which nursing action by the PMHNP would be of highest priority initially?
a. Assess her coping behaviors
b. Assess her current level of suicidality
c. Take her vital signs
d. Assess her health history
c. Take her vital signs
Impulsivity and suicidality are often associated with borderline PD. Which of the following pharmacological interventions is frequently used to reduce impulsivity and suicidality?
a. TCA
b. benzo
c. SSRI
d. MAOI
C. selective serotonin reuptake inhibitors
safest
Bipolar disorder: Mneumonic -Mania D I G F A S T
Distractibility Impulsivity-poor judgement, spending & reckless drive Grandiosity-increased self-esteem Flight of ideas-racing thoughts Activities-psychomotor agitation Sleep-decreased need Talkativeness-pressured speech
A male patient informs an adult PMHNP that he has not slept in three days, has poor concentration, and denies fatigue. The patient’s diagnosis is:
a. ADHD
b. bipolar disorder
c. panic disorder
d. primary insomnia
b. bipolar disorder
most likely dx on information provided
The neuroprotective treatment of choice for bipolar disorder is:
a. carbamazepine (Tegretol)
b. divalproex sodium (Depakote)
c. lithium (Eskalith)
d. risperidone (Risperdal)
c. lithium
Gold standard
According to current clinical guidelines for treating a patient bipolar disorder mania with psychotic features an adult PMHNP prescribes:
a. lithium
b. citalopram (Celexa)
c. lamotrigine (Lamictal)
d. quetiapine (Seroquel)
d. quetiapine (Seroquel)
while lithium is the gold standard for BP, but does not address the psychotic features.
Lamictal is for depression, no mania
A client comes into the clinic with longstanding history of depression and chronic renal failure. He is on an antidepressant and a diuretic and complains of increased depression, mild confusion, irritability, and overall apathy from being too tired to do anything. The best initial PMHNP action to take at this time is:
a. increase dose of antidepressant medication to better capture symptoms
b. change him to another antidepressant for better symptom control
c. augment his antidepressant with an atypical antipsychotic medication
d. order a CMP
d. order a CMP
Laboratory findings for a patient with an alcohol use disorder indicate increased liver function values and:
a. decreased MCV and normal triglyceride levles
b. elevated potassium and chloride levels
c. increased MCV and elevated triglyceride levels
d. increased urine and serum creatinine levels
c. increased MCV and elevated triglycerid levels
A 12 yo boy is brought to the psychiatrist because his mother says the boy is driving her “nuts”. She reports that he constantly argues with her and father, does not follow house rules and teases his sister. He is spiteful and vindictive and loses his temper easily. Once he is mad, he stays that way for long periods of time. The mother notes that the boy started this behavior only about 1 year previously. While she states that this behavior started at home, but is now interfering with school. The patient maintains that none of this is his fault, his parents are simply being unreasonable. He denies feeling depressed and notes that he sleeps well thorough the night. Which of the following is the most likely diagnosis?
a. ODD
b. antisocial PD
c. conduct disorder
d. intermittent explosive disorder
a. ODD
A middle-school boy repeatedly lies, steals, bullies’ peers, instigates flights harm without feeling any regret or remorse. These are characteristics of:
a. ODD
b. conduct disorder
c. disruptive behavior disorder
d. antisocial PD
b. conduct disorder
A 43 y/o man is admitted to the neurology service after he went blind suddenly on the morning of admission. The patient does not seem overly concerned with this sudden lack of vision. the only time he gets upset during the interview is when he is discussing his mother’s recent death in Mexico-he was supposed to bring his mother to the US but did not because he had been using drugs and did not save the necessary money. PE is completely negative. Which of the following is the most likely dx:
a. conversion disorder
b. adjustment disorder
c. MDD
d. hypochondriasis
a. conversion disorder
The neurochemical pathophysiology of Tourette’s disorder involves:
a. decreased level of GABA and increased levels of glutamate in the brain
b. deficits in the prefrontal cortex-medicated executive functions of the brain
c. imbalances in dopaminergic, serotonergic, and noradrengic systems in multiple regions of the brain
d. overstimulation of
c.
For the past 18 months, an 8 y/o exhibited involuntary, purposeless, rapid recurrent movements of the arms and face as well as spontaneous unintelligible vocalizations. When receiving verbal cues, the child can decrease an sometimes extinguish the erratic movements for several minutes. The dx is:
a. OCD
b. chronic motor tic disorder
c. stereotypic movement disorder
d. Tourette disorder
d. Tourette disorder.
Evidence based findings does not support use of which interventions to reduce symptoms in individuals with non-combat related PTSD:
a. anticonvulsants
b. EMDR
c. exposure based CBT
d. SSRIs
a. anticonvulsants
Which of the following structural changes is common in individuals with schizophrenia.
a. increased glutamate and decreased GABA release
b. increased electrical activity in the frontal lobes
c. increased size of the cerebral ventricles
d. increased total brain volume
c. increased size of the cerebral ventricles
A patient with a dx of schizophrenia has a hx of SI and attempts. The PMHNP should consider which antipsychotic medication that is the only antipsychotic to reduce the risk of suicide in schizophrenia?
a. abilify
b. latuda
c. invega
d. clozaril
d. clozaril (clozapine)
18y/o female dx with first episode of schizophrenia is amenable to take antipsychotic medication to lessen her hallucination. She is opposed to taking meds that would casue her to gain weight. Which medication would be the most appropriate to prescribe?
a. clozapine (
b. olanzapine (Zyprexa)
c. quetiapine (Seroquel)
d. ziprasdone (Geodon)
d. ziprasdone (Geodon)
A client who is experiencing difficulties with working memory, planning and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his or her knowledge that these symptoms represent problems with the:
a. frontal lobe
b. temporal lobe
c. parietal lobe
d. occipital lobe
a. frontal lobe
What part of the brain is responsible for regulating emotions
a. Wernicke’s area
b. Occipital lobe
c. Hippocampus
d. Parietal lobe
c. Hippocampus
Which of these brain structures puts emotional meaning on a stimulus, forms emotional memories, and is involved with rage and fear?
a. Hippocampus
b. Temporal lobe
c. Amygdala
d. Midbrain
c. Amygdala
A client presents with complaints of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions?
a. Thalamus
b. Hypothalamus
c. Limbic system
d. Hippocampus
b. Hypothalamus
Which serotonin receptor antagonism makes an antipsychotic “atypical”?
a. 5HT4A
b. 5HT2A
c. 5HT1A
d. 5HT3A
b. 5HT2A
45y/o AA male dx with chizophrenia arrives at your clinic for a regular medication appt. He is currently stabilized on Chlorpromazine. You notice his face appears mask-like, and he walks with a shuffling gait. Based on this information, what EPS side effect would you suspect?
a. akathisia
b. akinesia
c. dystonia
d. pseudo-Parkinson’s
d. pseudo-Parkinson’s
A patient has been treated for the past several years with fluphenazine (Prolixin). You notice that he is drooling and has a tremor and slight pill-rolling movement of the fingers. These are the EPS known as
a. Anticholinergic effects
b. pseudo-Parkinson’s
c. Tardive dyskinesia
d. Acute dystonia
d. pseudo-Parkinson’s
A patient is dx with schizophrenia. Which of the following would be the appropriate question for the PMHNP to ask when assessing side effects produced by dopamine antagonism in the nigrostriatal pathway?
a. are you experiencing constipation
b. pill rolling tremors, shuffling gait, masklike facial expression
c. are you experiencing increased thirst
d. are you experiencing breast discharge
b. pill rolling tremors, shuffling gait, masklike facial expression
Which of the following antidepressants is associated with the most cardiovascular adverse effects
a. sertraline
b. citalopram
c. bupropion
d. duloxetine
b. citalopram
The study of what a drug does to the body is called
a. pharmacodynamics
b. pharmacology
c. pharmacokinetics
d. distribution
a. pharmacodynamics
The study of drug absorption, distribution, metabolism, and excretion is known as
a. pharmacotherapeutics
b. pharmacodynamics
c. pharmacokinetics
d. pharmacy
c. pharmacokinetics
Sarah presents for her initial intake appt with complaints of depression. She is being treated for HTN and asthma by her PCP. Knowing that certain medications can cause or exacerbate depression; you obtain a complete medication history. Which of the following medications is known to exacerbate or cause depression:
a. omeprazole
b. propranolol
c. levothyroxine
d. clarithromycin
b. propranolol
A patient with a known dx of bipolar I disorder presents to your clinic complaining of manic symptoms and insomnia. Your patient has been stable on lithium for the past six months. To determine if a medication change or increase is warranted, it is important to gather more information. You suspect a possible medication-induced manic episode when the patient endorses what?
a. he was recently placed on a beta blocker for anxiety
b. she was recently prescribed a benzo by her PCP for panic attacks
c. she recently had an acute flare-up of her rheumatoid arthritis and received treatment for 1 wk for stabilization of symptoms
d. she recently began a new retroviral regimen for hepatitis
c. she recently had an acute flare-up of her rheumatoid arthritis and received treatment for 1 wk for stabilization of symptoms
John is a 58 y/o male patient with Bipolar I has been stable for 5 years on valproate and seroquel. He was recently started on flonase by his PCP. As PMHNP for John, you are concerned that the addition of the flonase may cause
a. HTN crisis
b. SJS
c. NMS
d. manic episode
d. manic episode
16 y/o boy presents with a long head, large ears and hyperextensible joints is very shy and starts rocking and flapping his hands when he is upset. Which of the following is the most likely dx
a. Tourette disorder
b. Autism spectrum disorder
c. Fragile x syndrome
d. Rett disorder
c. Fragile x syndrome
What muscle relaxant is recommended to be used in the treatment of NMS?
a. Bromocriptine
b. Trihexyphenidyl
c. Dantrolene
d. Benztropine
c. Dantrolene
A wk after raising the dose of clomipramine a patient treated for depression presents with reports of acute mental status changes, fever, and hyperreflexia. As the treating PMHNP, you know these symptoms are consistent with which of the following:
a. EPS effects
b. NMS
c. Serotonin syndrome
d. HTN crisis
c. Serotonin syndrome
24 y/o female attempts suicide by OD with MAOI phenelzine. She is stabilized at the hospital. 10 days later she is started on venlafaxine and becomes tachycardic and diaphoretic, and she develops myoclonic jerks. What condition is this?
a. NMS
b. Opisthotonos
c. akathisia
d. Serotonin syndrome
d. Serotonin syndrome
17 y/o patient arrives at the ED with nonspecific complaints. The patient’s temp is 100.8, pulse rate and BP are elevated and pupils are dilated with decreased rxn to light. 2 days ago, the patient began taking sertraline 50,g daily for the treatment of depression. The patient has a history of SUD and smoked marijuana one week ago the dx is:
a. ETOH withdrawal
b. infection affecting the CNS
c. NMS
d. serotonin syndrome
d. Serotonin syndrome
Pt being treated for psychosis for 2 weeks develops symptoms of NMS. The following factors help PMHNP to differentiate NMS from serotonin syndrome:
a. autonomic instability, diaphoresis, tremors
b. hyperthermia, leukopenia, tachy
c. rigidity, hyperreflexia, orthostatic hypotension
d. mutism, leukocytosis, myoglobinuria
d. mutism, leukocytosis, myoglobinuria
When studying pharmacodynamics involving receptors, you know that an agonist produces the following effect
a. does not fully activate the receptor and causes only limited actions.
b. blocks the agonist from opening the channel and does not activate a biological response
c. causes the opposite effect of agonist and causes the receptor to close the ion channel
d. activates a biological response and opens the ion channel.
d. activates a biological response and opens the ion channel.
During a follow up assessment, a PMHNP asks pt to count backwards from 100 by 7s. What aspect of the MSE is being assessed?
a. Orientation
b. Language
c. Thought content
d. Concentration
d. Concentration
Appraisal of the patient’s SI, plan, method, intent, and access to implementation plan would be documented in which part of standard psych eval?
a. ROS
b. Diagnosis
c. MSE
d. HPI
c. MSE
48 y/o Caucasian male presents for his therapy session. He is sad about losing his wife recently to COVID-19. He reports feeling thoughts of hurting himself. He has a past history of OD on propranolol several years ago. Which of the following places him at higher risk for suicide?
a. Previous suicide attempt
b. age
c. gender
d. marital status
a. Previous suicide attempt
Which of the following patient is at a higher risk of suicide?
a. 30 y/o married AA female with previous suicide attempt
b. 35 y/o single Asian male with previous suicide attempt
c. 38 y/o single African male who is a manager of a bank
d. 68 y/ single Caucasian male with depression
d. 68 y/ single Caucasian male with depression
64 y/o C male referred for treatment of refractory depression by his PCP reports continued lack of purpose, insomnia, decreased energy, reduced interest in pleasurable activities since losing his wife hit by a drunk driver 3 mo ago. Which of the following is the assessment priority?
a. prior and current meds, dose, clinical response, side effects
b. thoughts of self harm, plan, intent, access
c. extent of ETOH use and motivation to reduce to safe levels
d. sleep pattern and hygiene.
b. thoughts of self harm, plan, intent, access
A married female patient has been in therapy with PMHNP for 3 months. The patient’s husband abuses alcohol and refuses treatment. The night before the next scheduled appointment, the patient telephones the CNS stating that her husband is drunk, violent and threatening to kill her. The PMHNP’s priority intervention is to:
a. arrange for an emergency psychiatric evaluation
b. arrange for the woman’s safety
c. request a restraining order
d. request to speak with the husband
b. arrange for the woman’s safety
A client says to the PMHNP, “Some days life is just not worth it. All my wife and I ever do is fight and scream. Things at home would be calmer and simpler if I just wasn’t there anymore.” The most therapeutic response for the PMHNP to make is
a. do you mean that you are thinking about leaving your wife and moving out
b. tell me what you mean by it would be simpler if you just weren’t there anymore
c. so you are thinking suicide might be an option for you?
d. remain silent
b. tell me what you mean by it would be simpler if you just weren’t there anymore
While working with an older male client, the nurse begins to think that the client reminds her of her grandfather and responds as if she was the granddaughter. The nurse is developing which of the following?
a. empathy
b. modeling
c. transference
d. countertransference
d. countertransference
According to Erikson’s Psychosocial Stages of Development, in what stage does the child need to learn important academic skills and compare favorably with peers in school to achieve competence?
a. Trust v Mistrust
b. Identity v Role Confusion
c. Initiative v Guilt
d. Industry v Inferiority
d. Industry v Inferiority
According to Erikson’s stages of human development, the key event for people between the ages of 35-65 (generativity v stagnation) is:
a. Independence
b. Love relationship
c. reflection/acceptance of one’s life
d. Parenting
d. Parenting
A 2 y/o baby is displaying low self-esteem, poor self-control, self-doubt, and a high level of dependency. These behaviors indicate developmental failure of which of the following stages of development:
a. infancy
b. early childhood
c. late childhood
d. school age
b. early childhood
38 y/o woman quits her high paying marketing job to focus on her children and become a school counselor. What stage would Erikson consider this to be:
a. Identity v role confusion
b. Generativity v stagnation
c. ego integrity v despair
d. industry v inferiority
b. Generativity v stagnation
