PMHNP Review Questions Flashcards by Leticia Vance

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

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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

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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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.

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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

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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

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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)

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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)

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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

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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

Definition: describes a child's ability to know that objects continue to exist even though they can no longer be seen or heard

Object permanence

Definition: allows us to trust that our bond with those who are close to us remains whole even when they are not physically around. Absence does not mean disappearance or abandonment, only temporary distance

Object constancy

A patient with borderline PD experiences intense anxiety when the PMHNP goes on vacation. The best explanation for this reaction is that the patient: a. pt is developing countertransference b. has failed to master object constancy c. is employing primitive idealization d. is employing devaluation

b. has failed to master object constancy

Definition: way of coping with anxiety in which an object or person of ambivalence is viewed as perfect, or as having exaggerated positive qualities

Idealization

Definition: used when a person attributes themselves, an object or another person as completely flawed, worthless or as having exaggerated negative qulaities

Devaluation

32 y/o male with hx of COPD, T2DM, HTN and new onset severe physiologic tremor presents to the clinic with his wife. The wife is worried that the patient is misusing alcoholic beverages to self-treat his tremors. He has begun missing their children's school events and coming home late. He also has more mood swings. Upon questioning the patient, he admits to increasing his overall alcohol intake. However, he does not acknowledge that he has a problem with alcohol and is in control. VS are stable, and medications are appropriately reconciled and refilled. Which of the following questionnaire criterion available for use and at what stage of recovery does the pt stand a. CAGE / relapse b. CAGE / pre-contemplation c. CAGE / action d. CAGE / contemplation

b. CAGE / pre-contemplation

When working with a 26 y/o, Mike who presents for tx of cannabis use and gambling, you use MI techniques. As a PMHNP, you are familiar with the core counseling skills used in MI. Mike made the following statements:: "I don't know why I came here in the first place, but I thought maybe some medication would help me" you respond, You're feeling confused about the process and Mike replies, "I never thought I'd need to come to a place like this" you respond, "you kept your appointment today and I appreciate the courage it took for you to come here." What 2 MI techniques are used in this interaction? a. interrupting and reassurance b. affirming and reflecting c. open ended question

b. affirming and reflecting

Which behavior reflects existentially oriented therapy a. attempting to understand a pt's subjective world b. challenging a pt's irrational beliefs c. developing specific plans of change d. Est general group goalsc.

a. attempting to understand a pt's subjective world

Est. clinical guidelines suggest the suicidality is decreased by treating pts who have borderline PD with a. EMDR b. CBT c. DBT d. interpersonal therapy

c. DBT

DBT draws on cognitive theory and behaavioral theory, along with other theories. Elements of behavioral therapy in DBT include which of the following a. skills training and exposure b. examination of feelings and relating feelings to visceral sensation c. working through the transference with the therapist d. cognitive interpretation of past traumatic experiences.

a. skills training and exposure

A 55 y/o pt with generalized anxiety disorder arrives at your clinic for her weekly therapy appt. You have been counseling her for the past year. Today, she appears unusually gloomy, and her eyes are bloodshot as if she had just been crying. She tells you that she is worried that she will never get better, and she will always feel this way. As the NP, you understand that this pt has negative distorted beliefs about herself and her illness. What individual therapy method is most appropriate to use in helping this client through her current crisis? a. Cognitive therapy b. EMDR c. DBT d. existential therapy

a. Cognitive therapy

Which nonpharmacologic treatment modality is recommended for depression a. biofeedback b. DBT c. EMDR d. supportive group therapy

d. supportive group therapy

When working with a family in therapy, you plan to address differentiation of self triangles, and genomes. What family therapy approval will you be using. a. DBT b. Strategic family therapy c. Systemic family therapy d. Structural family therapy

c. Systemic family therapy

Patient would like to try acupuncture to her routine to help manage her depression. Your best response is: a. acupuncture is an integrative therapy, but it is least effective in improving depression b. integrative therapies have no effectiveness in improving depressive symptoms c. integrative studies are not well studied, and I cannot recommend you add this d. Acupuncture has been found to help some individuals with depression. While data is limited if this is something you would like to consider, let's talk about where you might find a reputable practitioner.

d. Acupuncture has been found to help some individuals with depression. While data is limited if this is something you would like to consider, let's talk about where you might find a reputable practitioner.

When working with an avoidant patient with a history of trauma, what type of communication techniques are helpful? a. techniques to decrease arousal b. clarification and close-ended questions c. techniques to increase arousal d. reflection and open-ended question

c. techniques to increase arousal

Working with a 48 y/o pt recently diagnosed with schizophrenia and working using a recovery model a. focus on his feelings, interests and dreams b. assist finding a job c. focus on side effects of meds d. psychoeducation

a. focus on his feelings, interests and dreams

Any court of law that evaluates the standards of care provided by PMHNP: a. compares the actions to the standard of care provided by a psychiatrist b. considers what a reasonably prudent PMHNP would do in the same or similar circumstances c. evaluates patient satisfaction data reviews the NP's charts for similar patients.

b. considers what a reasonably prudent PMHNP would do in the same or similar circumstances

The parent or legal guardian of a 7 y/o child must approve any medication orders, because a child this age fails to meet which two of the five elements of informed consent a. autonomy and veracity b. competence and comprehension c. confidentiality and beneficence d. disclosure of information and voluntariness

b. competence and comprehension

A new male patient has a 10yr hx of substance abuse, depression and anxiety. He is requesting Xanax. Which principle should the PMHNP employ moving forward. a. beneficence b. fidelity c. non-maleficence d. veracity

c. non-maleficence | - do no harm! safety

A newly graduated PMNHNP is working as a case manager for clients who have severe mental illness. As required, the PMHNP maintains in-depth and accurate client records of: a. appointment hx b. imaging results c. insurance coverage d. the treatment plans

d. the treatment plans

A PMNHNP notices that few substances abuse treatment programs apply EBP. The PMHNP wants to initiate such a treatment program to: a. implement the use of valid instruments b. improve outcomes through analysis and synthesis of evidence c. maximize interventions and increase skill utilization d. optimize revenue-generating potential

b. improve outcomes through analysis and synthesis of evidence

A PMHNP recognizes that a number of his or her colleagues are prescribing a certain medication for an off-label use. The PMHNP initial action is to: a. conduct a literature search to determine whether data support the off-label use b. contact the pharmaceutical manufacturer to request related research findings. c. prescribe the medication for off-label use d. report the colleagues to the state BoN

a. conduct a literature search to determine whether data support the off-label use

A PMHNP and a staff nurse are discussing the amount of time required to perform safety rounds on a psychiatric inpatient unit. An initial evidence-based approach for investigating this topic is to: a. conduct a time study b. identify community standards c. perform a literature search d. survey the nursing staff

c. perform a literature search

The evidence hierarchy ranks sources of knowledge according to the strength of information they provide. Which of the following would you find in Level 1 of an evidence hierarchy? a. meta analysis b. cohort studies c. opinions of expert committees d. case control

a. meta analysis

While providing a history, a patient request that a PMHNP disclose the information gathered with no one but the patient's spouse. By respecting this request, the nurse practitioner demonstrates which component of a therapeutic relationship. a. nonmaleficience b. beneficence c. confidentiality d. empathy

c. confidentiality

Mr. Smithers, an involuntarily hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered medication because he believes "Jesus Christ told him I am the prophet and must fast for a year." Your actions should be based on your knowledge of which of the following a. Psych pt cannot refuse treatment b. psych pt do not always know what is good for them c. psych pt can refuse treatment d. psych pt cannot be trusted to make good healthcare decisions and , therefore the nurse's best clinical judgment should guide action

c. psych pt can refuse treatment

The PMHNP is asked to consult with a local inpatient psychiatric facility to provide nursing staff development. After meeting with the administrator to identify the nature of the problem requiring the consultation, the PMHNP's next step is to: a. create an interdisciplinary teaching team b. develop outcome measures c. market the educational plan d. utilize a survey to assess the educational needs of the staff

d. utilize a survey to assess the educational needs of the staff

Before implementing evidence-based practice changes, an adult psychiatric and mental health NP's initial action is to: a. brainstorm with stakeholders and draft a detailed problem list b. compare data with internal and external benchmarks and coordinate ongoing education c. facilitate a collaborative multidisciplinary group to synthesize evidence and compare key themes d. identify potential barriers and facilitators that reflect patients' values and expectations.

d. identify potential barriers and facilitators that reflect patients' values and expectations.

The PMHNP has a law Bill in the senate legislature passed so that funds will be released to be used for housing the severe and persistently mentally ill. Teh PMHNP contacts 8 persons and asks them to telephone the State Senate who heads the HHS committee, she asks them to tell the Stat Senator to vote to approve the bill. The NP is acting as an? a. care provider b. advocate c. policy maker d. stigma reduction agent

b. advocate

If a patient from a specific culture is refusing accept any diagnosis of mental health disorders because of shame, what could be done to address this barrier? a. educate the family b. political advocacy c. public health concern d. community education programs

d. community education programs stigma, largest audience

Mary is a PMHNP who is working in a hospialist role. Mary has encountered over 5 incidences in which attending psychiatrists and medical residents have been demeaning to nursing staff and not answering calls in the middle of the night or telling the nursing staff to write orders and the MD would sign off in the a.m. Mary is concerned about errors and want to improve quality, reduce errors to promote safety. What concept is Mary

d. just culture

The PMHNP is concerned about access-to-care issues in the local community and wants to help develop health care policy to help patients access care more effectively. The NP knows one of the most effective avenues for developing and advocating for policy is: a. asking the clinical manager to explore options for access b. organizing a political protest c. working with the local chapter of the nurse's professional association d. writing letters to the editor of the local newspaper

c. working with the local chapter of the nurse's professional association

A hospital-based PMHNP collaborates with a multidisciplinary team that is charged with establishing a psychiatric outpatient clinic. Advocating for the role of APN, the NP initially educates the team that APNs: a. are readily available to meet patient needs b. can autonomously provide a full range of comprehensive services c. can perform case management function d. provide cost-effective care delivery.

b. can autonomously provide a full range of comprehensive services all yes, b is most umbrella

A PMHNP is leading an interdisciplinary group that is developing treatment plans for patients with schizophrenia. During the 2nd meeting, the nurse manager becomes resistant to the idea and negative about its implementation. This is an important project and the support of the manager will be needed. The PMHNP's best response to the situation is to: a. meet individually with the nurse manager to discuss the perceived resistance. b. report the situation to the nursing director and ask for administrative intervention. c. revisit the initial goals of the group at the next meeting and ask for comments d. Schedule another meeting of the group and move through the agenda since the majority of the group is very supportive

a. meet individually with the nurse manager to discuss the perceived resistance.

The CNP of a large behavioral health system approached the PMHNP to discuss the new Healthcare Effectiveness Data and Information Set (HEDIS) behavioral health measures and specifications. The PMHNP is asked to do a retrospective chart review of all hospital discharge clients who received a follow-up visit w/in 7 days of discharge and within 30 days of discharge. The PMHNP has been asked to engage in which of the following? a. needs assessment project b. plan, do, study, act project c. a task that is outside of the PMHNP's scope of practice d. quality improvement initiative

d. quality improvement initiative

IN a quality assurance program, a retrospective audit involves: a. examining the charts of discharged patients and using specific criteria to determine the quality of patient care b. inspecting the facility to monitor the therapeutic quality of the environment and to suggest improvements c. reviewing patients charts to determine how appropriately hospital resources are being used. d. using a case conference format for staff to discuss ways to improve a particular patient's care

a. examining the charts of discharged patients and using specific criteria to determine the quality of patient care

The psychiatric-mental health nurse practitioner is responsible for initiating quality improvement at a community mental health clinic. The effective strategy for evaluating the clinic's services is to: a. a chart review analysis b. a root cause analysis c. plan-do-study-act process d. failure effect mode analysis

c. plan-do-study-act process

The PMHNP participates in a hospital-based quality improvement project. The NP reviews 4 charts per month of a NP colleague to ensure diabetes protocols are met. This process is a: a. core competency b. forced field analysisi c. peer review d. risk analysis

c. peer review

The PMHNP evaluates a new adult patient via telemedicine. The patient has questions about a new medication that he or she recently started. TH NP decides to provide psychoeducation and to: a. email drug information and resources b. encourage the patient to seek information on the internet c. have a phone conference with a family member d. refer pt to a local PCP

a. email drug information and resources

A 69 y/o Cameroonian female, who recently moved to the US 4 wks ago, comes to your clinic for an evaluation. Her first language is French, and she does not speak English. She did not finish HS and has problems with reading and writing. As the PMHNP, was is your priority disparity to address with this patient? a. race b. age c. reading level d. health literacy

d. health literacy more broad

The members of a 2nd gen family of Mediterranean ancestry express concern about their immigrant grandmother's behavior. She persists in wearing heavy black clothing, secludes herself from the family, and prays throughout the day. Although she has no known health problems and appears to be healthy, she frequently discusses her impending death. The PMHNP assesses the grandmother based on the knowledge that: a. cultural factors may negate the significance of seemingly obvious symptoms b. religious fixations are common in delusional systems c. she is exhibiting the classic signs of a major depressive disorder d. suicide is common among older adults

a. cultural factors may negate the significance of seemingly obvious symptoms

In counseling a 23 y/o married, Hispanic mother who brought her 4 y/o son to clinic for "mal de ojo" with symptoms of fitful sleep, diarrhea, vomiting and fever, the PMHNP: a. identifies what steps the mother has already tried in caring for the child's symptoms b. explains that the symptoms are most likely caused by viral infection c. educates about importance of maintaining fluid and electrolyte imbalance d. respect the mother's understanding of the child's illness

d. respect the mother's understanding of the child's illness

A PMHNP working in a child and adolescent psychiatric unit meets regularly with the staff nurses of an adolescent inpatient psychiatric unit to improve the nurses' therapeutic interactions with the patients. Each nurse keeps a journal describing clinical integrations with an adolescent and examines the factors that hinder the nurse's ability to interact therapeutically with the patient. The PMHNP reviews the entries and provides written feedback. This teaching strategy is known as: a. concept mapping b. discovery learning c. problem-based learning d. reflective practice

d. reflective practice

Your patient with bipolar disorder is admitted to medical hospital. The internist calls your office to ask if the lithium prescribed can affect his ECG. You answer: a. lithium can prolong the QT interval b. lithium has no effect on ECG c. lithium can invert the t-waves d. lithium can shorten PR interval

c. lithium can invert the t-waves

Mary a 45 y/o AA female who has been treated on Isocarboxazid (Marplan) for 6 yrs. She is scheduled for a surgical procedure. Which medication is strictly contraindicated with Isocarboxazid? a. Morphine b. NSAIDs c. Methylphenidate d. Acetaminophen

c. Methylphenidate

You are treating a client with schizophrenia who takes clozapine. What laboratory values will indicate client needs to d/c treatment: a. WBC of less than 1800; ANC less than 1700 b. ANC less than 1000 c. WBC lees than 5000 d. ANC less than 2000

b. ANC less than 1000

Which mood stabilizer is associated with potential life-threatening rash in the Asian population. a. Carbamazepine b. Depakote c. Lithium d. Lamictal

a. Carbamazepine

Which of the following physical exam findings would help differentiate anorexia nervosa and bulimia nervosa a. Russell sign b. low body mass index c. erosion of dental enamel d. Hypertrophy of salivary glands

b. low body mass index

Which of the medication has a unique mechanism that is both a norepinephrine and dopamine reuptake inhibitor a. Bupropion (Wellbutrin) b. Sertraline (Zoloft) c. chomipramine (Anafranil) d. Duloxetine (Cymbalta)

a. Bupropion (Wellbutrin)

Which CYP enzyme is implicated as a tobacco inducer when an individual is treated with clozapine. a. 2D6 b. 1A2 c. 2C19 d. 2C9

b. 1A2

For 12years, a 65-y/o pt with bipolar affective disorder has been treated with lithium 900 mg daily. When oral HCTZ 12.5mg daily added for HTN, the patient develops N/V/ataxia and musle weakness and the patient's serum lithium is 2.0. The interaction of the lithium and the HTCZ has induced a. hypokalemia b. hyponatremia c. increased renal clearance of lithium d. decreased renal clearance of lithium

d. decreased renal clearance of lithium

Serotonin is neurotransmitter that is implicated in sleep and mood. What area of the brain has a large majority of serotonin neurons? a. Raphe nuclei b. Nucleus Accumbens c. Locus Coeruleus d. Amygdala

a. Raphe nuclei

A 5 y/o shows no interest in playing with other children and ignores adults other than parents. He spends hours lining up his toy cars or spinning their wheels. He rarely uses speech to communicate, and his parents state that he has never done so. PE indicates head is of normal circumference and his gait is normal. Which of the following is the most likely diagnosis for this boy? a. OCD b. Rett syndrome c. Autism d. Tourette's

c. Autism

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 their knowledge that these symptoms represent problems with the a. frontal lobe b. temporal lobe c. parietal lobe d. occipital lobe

a. frontal lobe

Which 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 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

45 y/o AA male with schizo arrives at clinic for reg med check. on clomazipine, face is mask-like and shuffling gait. What EPS would you suspect. a. akathisia b. akinesia c. dystonia d. pseudo-parkinson

d. pseudo-Parkinson

A pt treated with phophenazine drooling and pill-rolling; EPS symptoms are: a. ACH effects b. pseudo parkinsonism c. tardive dyskinesia d. acute dystonism

b. pseudo parkinsonism

Pt dx with schizo, which of the following is the appropriate question when looking for s/s when assessing Nigrostriatal pathway a. are you experiencing constipation b. pill-rolling, tremors, shuffle gait & mask like face expression c. increase thirst d. breast discharge

b. pill-rolling, tremors, shuffle gait & mask like face expression

which of the following with anti-depressants associated with most cardiovascular side effects. a. sertraline b. citalopram c. buspar d. duloxetine

b. citalopram

The study of what drugs do to the body a. pharmacodynamics b. pharmacokinetics c. Distribution d. Pharmacology

a. pharmacodynamics

The study of drug metabolism, absorptions, distribution, and excretion a. pharmacotherapeutics b. pharmacodynamics c. pharmacokinetics d. pharmacology

c. pharmacokinetics

``` Initial intake appt with w/ cc of depression; treated for HTN and asthma by PCP. Knowing that certain meds can cause or exacerbate depression, obtain med hx, which med is known to increase depression a. omeprazole b. propranolol c. levothyroxine d. ```

b. propranolol

A pt with known dx with BP I, present to clinic with c/o manic symptoms and insomnia. Has been stable on lithium for several months. which drug pt endorses can cause mania a. Beta blocker for anxiety, b. benzo for panic, c. RA flare treated d. retroviral

c. RA flare treated

58 y/o male with BP I, stable for 5 years on valproic and seroquel. Recently started on flonase by PCP, concerned that flonase may cause: a. HTN crisis b. SJS c. NMS d. manic episode

d. manic episode

16 y/o boy, long head and ears with hyperflexible joints, is shy is rocking and flapping hands when upset. Dx? a. Tourette's b. Autism Spectrum c. Fragile X d. Rett

c. Fragile X

muscle relaxant is recommended to be used in the treatment of NMS a. bromazine b. ? c. dantrolene d. benztropine

c. dantrolene

A week after raising the dose of clomiprimine pt has the symptoms of fever, AMS and hyperreflexia a. EPS b. NMS c. Serotonin syndrome d. HTN crisis

c. Serotonin syndrome

24 y/o female attempts OD with MAOI, she needs stabilized at hospital, 10 days later was started on SNRI present begins to be tachy, diaphoretic and has myoclonic jerks a. NMS b. ? c. akathisia d. serotonin syndrome

d. serotonin syndrome

17 y/o pt arrives to ER with non-specific complaints. pupils dilated, fever, increased pulse and HTN Pt began sertraline 2 days ago, has hx of drug abuse a. ETOH withdrawal b. systemic infection c. NMS d. Serotonin syndrome

d. Serotonin syndrome

Psychosis, symptoms of NMS. How does the NP differentiate NMS from Serotonin syndrome a. autonomic symptoms b. hyperthermia c. hyper-reflexia and rigidity d. mutism, agranulocytosis, myoglobulinurea, leukocytosis

d. mutism, agranulocytosis, myoglobulinurea, leukocytosis

when starting pharmodynamic; an agonist does the following a. does not fully activate receptor and only causes partial effects b. blocks agonist from opening channel does not activate a biological response c. causes opposite effects and close ion channel d. affects biological effect and opens ions channel

d. affects biological effect and opens ions channel

during f/u asks pt to count backward by 7 this is: a. orientation b. language c. thought content d. concentration

d. concentration

Info about SI, access, plan....is charted under a. ROS b. Dx c. Mental status exam, thought content d. HPI

c. Mental status exam, thought content

which pt is highest risk for suicide a. 30 y.o male married previous SI attempt b. 35 single male, Asian with previous SI c. 38 AA male, single d. 68 y.o single Caucasian male with depression

d. 68 y.o single Caucasian male with depression (5 risk factors)

64 y/o C male referred for tx of refractory depression; has lack of purpose, insomnia, reduced pleasure since losing wife to DUI MVA. Which is an assessment priority. a. current meds b. self harm, plan, intent access c. motivation d. sleep pattern

b. self harm, plan, intent access

A 69 y/o man with a diagnosis of delirium has symptoms of psychosis which include frightening auditory and visual hallucinations and paranoid delusions. Which of the following medications should be chosen first for this man's symptoms? a. Haloperidol b. Quetiapine c. Valium d. Olanzapine

a. Haloperidol

An 81 y/o female with a history of vascular dementia is brought to the hospital for increased agitation and UTI. Which of the following features most distinguishes the effects of delirium from dementia? a. altered level of consciousness b. behavioral disturbances c. cognitive deficits d. language difficulties

a. altered level of consciousness

What is the best treatment for AIDS dementia complex. a. acetylcholinesterase inhibitors b. symptom-targeted pharmacologic treatments c. nonpharmacologic supportive care d. antiretroviral therapy.

d. antiretroviral therapy

A community has a unusually high incidence of depression and drug use among the teenage populations. The public health nurses decide to address this problem, in part, by modifying the environment and strengthening the capacities of families to prevent the development of new cases of depression and drug use. What is this an example of? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Protective factorial prevention

a. Primary prevention

A patient who was diagnosed with MDD comes to the clinic for a refill of sertraline (Zoloft) The PMHNP explains that the medication is prescribed for: a. Universal prevention. b. Primary prevention c. Secondary prevention d. Tertiary prevention

d. Tertiary prevention

According to the DSM-V, to diagnose ADHD, a PMHNP assesses a child's a. ability to listen when directly addressed b. ability to remain seated in a classroom c. behavioral fx, both at home and at school d. intellectual fx, based on psychometric testing

c. behavioral fx, both at home and at school

Tommy is an 8 y/o who presents to the PMHNP for evaluation of ADHD. His mother completed teh Vanderbilt ADHD rating scale and brought in the Vanderbilt teaching rating scale. Both your clinical interview and the rating scales indicate Tommy has ADHD. What assessment indicators need to be completed prior to starting a stimulant medication. a. Get a copy of the rating scale completed by his grandparents b. Assess for family history of cardiovascular disease and, if positive for conduction problems, order an ECG before prescribing medication c. Obtain blood pressure, and pulse, and begin the simulant medication d. Assess for a family history of bipolar disorder.

b. Assess for family history of cardiovascular disease and, if positive for conduction problems, order an ECG before prescribing medication