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midterm 2 Flashcards

1
Q

Which of the following is not a core competency of APRNs

A

Delegated practice

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 29). Springer Publishing Company. Kindle Edition.

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2
Q

Which of the following is characteristic of the leadership competency for APRNs?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 29). Springer Publishing Company. Kindle Edition.

A

Participating in a community-focused program that promotes mental health and reduces the risk of mental health problems

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 29). Springer Publishing Company. Kindle Edition.

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3
Q

All of the following are characteristic of the independent practice competency except:

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 29). Springer Publishing Company. Kindle Edition.

A

Taking opportunities to influence health policy to reduce the stigma of mental health services

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 29). Springer Publishing Company. Kindle Edition.

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4
Q

A state’s Nurse Practice Act specifies all of the following except:

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 29). Springer Publishing Company. Kindle Edition.

A

Provide oversight for service and benefits provided to patients

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 29). Springer Publishing Company. Kindle Edition.

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5
Q

Which of the following may govern the profession of the PMHNP?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 29). Springer Publishing Company. Kindle Edition.

A

Statuatory Law

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6
Q

Which of the following factors are facilitating the growth of the PMHNP?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 29). Springer Publishing Company. Kindle Edition.

A

Decreasing stigma

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7
Q

Why is it necessary for insurance companies to credential PMHNPs?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 29). Springer Publishing Company. Kindle Edition.

A

To protect the public by ensuring a minimum level of professional competence

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 29). Springer Publishing Company. Kindle Edition.

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8
Q

All of the following statements are true regarding scope of practice except:

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 29). Springer Publishing Company. Kindle Edition.

A

The scope of practice provides a way to judge the nature of the care provided

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 29). Springer Publishing Company. Kindle Edition.

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9
Q

All the following statements are true regarding standards of practice except:

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (pp. 29-30). Springer Publishing Company. Kindle Edition.

A

Standards of practice identify competencies assumed to be held by all nurse practitioners (NPs) who function in a similar role

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 30). Springer Publishing Company. Kindle Edition.

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10
Q

All of the following are considered personal health identifiers except:

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 30). Springer Publishing Company. Kindle Edition.

A

Patient’s diagnosis

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 30). Springer Publishing Company. Kindle Edition.

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11
Q

A PMHNP is asked to determine if the patient has the capacity for informed consent. All of the following elements are necessary for making this determination except:

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 30). Springer Publishing Company. Kindle Edition.

A

The patient has a therapeutic alliance with the surgeon

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 30). Springer Publishing Company. Kindle Edition.

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12
Q

The patient has a therapeutic alliance with the surgeon

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 30). Springer Publishing Company. Kindle Edition.

A

The patient is unable to afford the cost of treatment

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 31). Springer Publishing Company. Kindle Edition.

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13
Q

A PMHNP is working with a nonprofit organization to implement a public health campaign aimed at reducing the stigma of mental illness. Which role of the PMHNP best describes this activity?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 31). Springer Publishing Company. Kindle Edition.

A

advocacy

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14
Q

The PMHNP is working with an insurance organization to provide oversight and authorization of series and benefits to patients. Which role of the PMHNP best describes this activity?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 31). Springer Publishing Company. Kindle Edition.

A

case management

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15
Q

Which of the following roles of the PMHNP requires mutual respect and an interactive learning process to facilitate role development, competencies, and skill acquisition?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 31). Springer Publishing Company. Kindle Edition.

A

mentoring

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16
Q

All of the following are true regarding living wills except:

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 31). Springer Publishing Company. Kindle Edition.

A

Legally binding in all 50 states

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 31). Springer Publishing Company. Kindle Edition.

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17
Q

A new graduate PMHNP is considering a job at a psychiatric ED. The medical director informs the prospective hire that they are expected to evaluate and treat children, adolescents, adults, and geriatric patients. What document should be consulted to determine if the PMHNP can legally treat psychiatric patients across the life span?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 32). Springer Publishing Company. Kindle Edition.

A

The state Nurse Practice Act

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 32). Springer Publishing Company. Kindle Edition.

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18
Q

All patients have the right to all of the following except:

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 34). Springer Publishing Company. Kindle Edition.

A

to be treated by a physician

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19
Q

A middle-school girl who is timid to take any risks, prefers solitary activities, and A middle-school girl who is timid to take any risks, prefers solitary activities, and

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 57). Springer Publishing Company. Kindle Edition.

A

trust vs mistrust

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20
Q

A 36-year-old Korean male who has recently started attending graduate school complains of persistent abdominal pain despite an extensive gastrointestinal work-up including an upper and lower gastroscopy. Which of the following defense mechanisms is employed?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 58). Springer Publishing Company. Kindle Edition.

A

Conversion

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21
Q

When evaluating a new 40-year-old, 4-week postpartum woman complaining of fatigue, irritability, dry skin, and poor sleep quality for mood disorder, which of the following diagnostic tests should be ordered to aid in formulating a diagnosis?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 109). Springer Publishing Company. Kindle Edition.

A

Thyroid-stimulating hormone (TSH) and free T4

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 109). Springer Publishing Company. Kindle Edition.

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22
Q

A 24-year-old man has been stable on lithium 1,800 mg daily for 2 years. His most recent serum lithium level is 2.0. The patient has no signs or symptoms of toxicity. Which of the following is the best action by the PMHNP?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 109). Springer Publishing Company. Kindle Edition.

A

Repeat the lithium level and ensure it is a trough

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 109). Springer Publishing Company. Kindle Edition.

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23
Q

172A 48-year-old divorced Black woman is admitted to the inpatient psychiatric unit after a serious suicide attempt by overdosing on acetaminophen. She has been admitted seven times with similar presentations after failing multiple treatments with antidepressants. She has been unable to work and has lost interest in all activities she once enjoyed. For the last 2 weeks she has had increased sleep latency, early morning awakening, difficulty concentrating, fatigue, hopelessness, and poor appetite. Which of the following factors would make the PMHNP recommend electroconvulsive therapy (ECT) in lieu of other medication trials?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 172). Springer Publishing Company. Kindle Edition.

A

Melancholic depression with a history of poor response to medications

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 172). Springer Publishing Company. Kindle Edition.

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24
Q

The mother of a 19-year-old male is convinced his bipolar condition was caused by his drinking and drug use. Which of the following statements is true regarding bipolar disorder?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 172). Springer Publishing Company. Kindle Edition.

A

Bipolar disorder has a stronger genetic etiology than major depression.

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 172). Springer Publishing Company. Kindle Edition.

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25
Q

A patient has been prescribed sertraline 50 mg daily for the past year without adverse effects and remission of symptoms. The patient has missed the last two appointments but leaves a message that he feels “fantastic!” The wife called to reschedule a follow-up appointment, saying he has been giddy lately, emotionally labile, and spending money so frivolously that their account has been overdrawn. During the appointment the patient becomes hostile and tells the PMHNP that he is a phony, and not even a real doctor, and is having an affair with his wife. The patient is uninterruptible, with pressured speech. What pharmacological change is indicated?

A

Start valproic acid, stop sertraline

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 172). Springer Publishing Company. Kindle Edition.

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26
Q

173The certified nurse midwife is evaluating a 29-year-old woman 2 weeks postpartum and finds her neglecting her self-care and minimally attentive to the baby and will not allow anyone else to care for the baby. During the visit a PMHNP is able to provide webcam consultation and liaison services. Based on the information provided, what is the priority in the management of this patient?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (pp. 172-173). Springer Publishing Company. Kindle Edition.

A

admit to the hospital

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27
Q

A 40-year-old senior associate in a law firm presents for care complaining of fatigue and poor motivation to the degree that he has been avoiding work. His boss has encouraged him to take some time off. The patient also reports that his wife recently kicked him out of the house after discovering his third extramarital affair. For the last 2 weeks he has been sleeping 16 hours a day, poor appetite, and has overdrawn his account. He says that this is most unlike him in that he used to be able to get by on 5 hours of sleep a night, party hard, and work harder. What is the most likely

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 173). Springer Publishing Company. Kindle Edition.

A

BPD 2

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28
Q

A 60-year-old man has been treated for depression for the last 2 years with a medication he cannot remember. He reports that he has had increasing urinary hesitancy, xerostomia, and intermittent lightheadedness. Which of the following medications is this patient most likely prescribed?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 173). Springer Publishing Company. Kindle Edition.

A

Doxepin

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29
Q

A 35-year-old woman is being evaluated 7 months postpartum for recurrent thoughts about wanting to harm her baby by stabbing with a knife. She continues to breastfeed and care for the baby. Since having these thoughts, she has removed all sharp objects from the home and has started ordering take out food to feed her family. She is reluctant to share these thoughts with her husband. Which of the following medications

A

Sertraline

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30
Q

A 30-year-old G1P0,1 has become increasingly oddly related, neglecting self-care, sleeping much of the day, eating minimally, crying easily, and despite reassurance that her pregnancy is progressing normally, worries that she will lose the pregnancy. Which of the following medications is considered least harmful in pregnancy?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 174). Springer Publishing Company. Kindle Edition.

A

Sertraline

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31
Q

A pregnant woman with depression is reluctant to take medication for fear of causing her baby neonatal abstinence syndrome due to selective serotonin reuptake inhibitor (SSRI) medication. Her husband states they would like to use a faith healer instead. Which of the following is most accurate regarding the prognosis of depression during pregnancy?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 174). Springer Publishing Company. Kindle Edition.

A

The actual course of depression cannot be predicted

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 174). Springer Publishing Company. Kindle Edition.

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32
Q

A 25-year-old female is referred by her women’s health nurse practitioner for evaluation. The patient reports that the week before her period every month she feels angrier and is increasingly irritable, and has difficulty concentrating, low energy, and a desire to sleep more and eat more ice cream. These symptoms all seem to stop the week after her period. What is the most likely diagnosis?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 174). Springer Publishing Company. Kindle Edition.

A

PMDD

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33
Q

A 70-year-old man with a history of hypertension is being evaluated for late effects of a cerebrovascular accident. Which of the following conditions is most associated with microvascular ischemia?

A

Depression

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34
Q

A 25-year-old female presents to the emergency department, having just witnessed an accident. Her speech is pressured. She states, “There were a lot of people in need of care at the scene, and I should know because I have traveled to many Third World countries. I know how bad needs can get. The people were injured, and she was hit by a car before but did not suffer any injuries. There were a lot of police cars and ambulances.” The patient was triaged to psychiatry. The PMHNP describes her thought process as:

A

Circumstantial

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35
Q

A 45-year-old man is reporting chest pressure, difficulty breathing, numbness, and tingling in his hands and lips. He has been seen in the emergency department in which he underwent a negative cardiac workup. He was subsequently triaged to psychiatry for evaluation. The PMHNP asks how he came to the hospital. He states, “I felt awful, my heart was pounding, I was sweating so much, I thought I was going to die. My father had a similar problem, but he died 10 years ago.” Which of the following best describes the thought pattern?

A

Tangential

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36
Q

A 29-year-old man presents to the emergency department stating he is very anxious and feels his heart is going to beat out of his chest. He is diaphoretic, with pressured speech and unable to be calmed. A psychiatric consult was called because the patient seems uncooperative and a proper history cannot be obtained. Which of the following conditions must be excluded first?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 188). Springer Publishing Company. Kindle Edition.

A

cocaine

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37
Q

A 22-year-old medical student has had several episodes of impending doom over the last 4 months. The events last 10 to 20 minutes and are associated with tremor, sweating, dizziness, and being unable to concentrate. He is now perpetually worried that these attacks will happen when doing his clerkship. The PMHNP in the student health center diagnoses him with panic disorder without agoraphobia. Which medication is the first choice for this condition?

A

Fluoxetine

38
Q

An 18-year-old girl was visiting colleges with her family and was involved in a fatal car accident 2 weeks ago. Since that time, she continually has flashbacks, difficulty sleeping, persistent ruminations, and is afraid to drive. She has become apprehensive about her family members driving as well. What is the most appropriate diagnosis?

A

Acute Stress Disorder

39
Q

A 34-year-old woman comes to an appointment because she is bothered by disturbing and recurrent thoughts of harming her 7-month-old infant. She reports that her thoughts are distressing enough that she has removed all sharp objects from the kitchen so that she cannot stab her baby with a knife. She has not shared these thoughts with her husband for fear of how he may react to her. Which of the following is the most likely diagnosis?

A

OCD

40
Q

A 38-year-old Middle Eastern male veteran of Operation Iraqi Freedom is evaluated at the mental health clinic. He reports that he saw many of his battle buddies get killed in action. He has been stateside for 2 years, but since that time he has had trouble sleeping and as such he is very irritable to be around. He reports ongoing nightmares and flashbacks to an explosion and he feels on edge most of the time. He avoids large crowds and loud noises. He finds that having a few beers helps calm him and makes him more pleasant to be around and allows him to socialize rather than isolate himself. Which of the following medications should the PMHNP prescribe?

A

Sertraline

41
Q

A 32-year-old man presents on referral from his primary care provider. He reports a 6-month history of recurrent bouts of anxiety associated with chest pain, tachycardia, tremors, nausea, diaphoresis, and an impending sense of doom. The episodes last approximately 20 minutes and he is unable to identify a precipitating event. The patient has become increasingly isolated for fear of not wanting to have this sort of episode in public. The primary care provider started him on a selective serotonin reuptake inhibitor (SSRI) 6 months ago but he continues to have the symptoms. Which adjunctive psychotherapy would be most appropriate for this patient?

A

CBT

42
Q

A 29-year-old woman with a history of panic disorder requests a psychiatric home visit because she continues to experience feelings that her environment is not real. She states that this is very unsettling and, as a result, has stopped going out of her home. In formulating her case, the PMHNP would describe this symptom as the persistence of:

A

Derealization

43
Q

A 32-year-old White male was formerly employed as a corporate lawyer and has recently started his own business. He has started experiencing symptoms of intense anxiety when taking the subway to work. The symptoms include feeling short of breath, chest pressure, sweaty, irritable, and an impending sense of doom. The symptoms have persisted and worsened over time to where he has everything delivered and cannot leave the house. What is the most likely diagnosis

A

Agoraphobia

44
Q

A 30-year-old female is referred by her women’s health nurse practitioner for vaginismus. The woman is distraught and embarrassed because she has not been able to consummate her marriage. Which therapeutic technique would be most helpful?

A

Systemic desensitization

45
Q

A 15-year-old boy has refused to go to school for the past month. Every morning he has a new symptom or develops one and has to be picked up from school. When he is home, the symptoms disappear. On weekends the symptoms never present. What is the most likely diagnosis?

A

Separation anxiety

46
Q

Mr. B was recently promoted to the position of vice president at his company. He is charming, articulate, well dressed, and admired from afar. On one occasion a new subordinate challenged his decision. Mr. B responded with anger and passive aggressive tactics, leading the subordinate to cancel weekend plans to implement Mr. B’s idea. These personality traits are most consistent with which of the following

A

narcissitic

47
Q

Which of the following characteristics distinguishes narcissistic personality disorder from antisocial personality disorder

A

The lack of empathy manifested in impulsivity and aggression rather than the need for admiration

48
Q

A 50-year-old physician presents with complaints of fatigue, headache, abdominal distress, and weight loss. His husband reports increasing irritability, inattentiveness, and low libido over the last month. He was seen by his primary care provider, who just notified him he had pre-diabetes, hypercholesterolemia, and hypertension despite weight loss. These findings are most consistent with

A

Major depression

49
Q

An APRN recognizes the essential nature of primary prevention strategies for a community. Which of the following is an example of a primary prevention strategy?

A

A skills class for at risk adolescents

50
Q

In light of the recent school shootings, the local high schools have noticed an unusually high incidence of depressive symptoms and illicit drug use among their students. The PMHNP formulates a plan to address the problem. The goal of the program is to enhance the capabilities of families and teachers to identify antecedents of depression and drug use and to prevent new cases from developing. What level of prevention is this strategy?

A

primary

51
Q

A 39-year-old woman has been in therapy for the last 3 months. She has shown much improvement in her functioning and has developed much insight into her illness. This week during her session you discuss service determination, and she suddenly begins to demonstrate the first symptoms that brought her into therapy initially. She is now hesitant for discharge and wants to continue services as she is displaying regressed behavior. What is the best explanation for her symptom return?

A

A normal resistance seen in the termination time of therapy

52
Q

237A 30-year-old man reports low self-esteem, demonstrates poor self-control, exhibits much self-doubt, and requires a high degree of reassurance. What developmental task has he failed to master

A

Industry versus inferiority

53
Q

An ambulance brings a 26-year-old female to the emergency department after a suicide attempt by self-mutilation. Which of the following is the most critical factor to consider when conducting your assessment?

A

Hemodynamic stability

54
Q

For which of the following reasons are selective serotonin reuptake inhibitors (SSRIs) considered the first-line drug of choice for depression without psychotic features?

A

Difficulty in overdosing for suicidal patients

55
Q

Which of the following is an essential principle of cognitive behavioral therapy?

A

Recognizing and changing automatic thoughts

56
Q

The process by which the body affects the drug is known as:

A

Pharmacokinetics

57
Q

Which of the following neuroleptic mood stabilizing medications commonly used to treat bipolar disorder is associated with which teratogenic effects?

A

Lithium (Ebstein’s anomaly); divalproex (neural tube defects)

58
Q

239Which of the following classes of medications is thought to exacerbate or cause depression?

A

beta blockers

59
Q

A patient with chronic renal failure and type 2 diabetes is sent to the PMHNP with symptoms of depression marked by increasing fatigue, confusion, irritability, anhedonia, and apathy. Which of the following is the best action to take at this time?

A

Order blood work to evaluate his renal function and electrolytes

60
Q

A 36-year-old pharmacist has a history of depression and suicide attempt 1 month ago by hanging. She had been started on a tricyclic antidepressant but abruptly stopped taking the medication a week after she started saying it was “ineffective.” The PMHNP meets with this patient to plan care. Which of the following is the most appropriate initial action?

A

ask the patient how to help her

61
Q

A 90-year-old Black woman tells the PMHNP “some days life is just not worth living. I would be less of a burden if I were not here anymore.” The most therapeutic response for the PMHNP to make is

A

“Tell me what you mean when you say ‘life is not worth living’”

62
Q

240A client states that he “did not realize the time” and apologized for running late. The PMHNP replies “This is the fourth time in a row that you’ve been late to our sessions; I’m just wondering how committed you are to this therapy.” What communication technique was used by the PMHNP?

A

Presenting reality

63
Q

A patient is experiencing memory deficits, difficulty in prioritizing and planning, no insight into problems, and poor impulse control. Which lobe of the brain is responsible for the symptoms?

A

frontal lobe

64
Q

Which area of the brain regulates appetite, the sleep-wake cycle, and libido?

A

hypothalamus

65
Q

241Which of the following areas of the brain produces dopamine?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (pp. 240-241). Springer Publishing Company. Kindle Edition.

A

substantia nigra

66
Q

A patient who is not willing to discuss his involvement in a psychological trauma is using which of the following defense mechanisms?

A

denial

67
Q

A sole survivor from a house fire tells the PMHNP that she does not remember anything about how she got out. Which defense mechanism is being used?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 241). Springer Publishing Company. Kindle Edition.

A

repression

68
Q

A PMHNP in private practice is experiencing feelings of resentment toward a patient who missed his last two appointments at the last minute because he forgot. Which of the following is an example of a therapeutic response?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 245). Springer Publishing Company. Kindle Edition.

A

“Help me understand what’s going on so we can figure out how to proceed.”

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 245). Springer Publishing Company. Kindle Edition.

69
Q

246David is a 43-year-old veteran of Operation Iraqi Freedom. A PMHNP is currently treating him for generalized anxiety disorder and major depressive disorder. During their last visit the PMHNP learned that David had a blast injury and sustained head trauma during his tour in Iraq. At the time he was diagnosed with a traumatic brain injury. His current regimen includes fluoxetine 40 mg daily and clonazepam 1 mg twice daily. In light of this new information what are some potential adverse effects?

A

Benzodiazepines cause memory problems and confusion in clients with a history of traumatic brain injury

70
Q

A new psychotropic drug is on the market with an indication for schizophrenia and bipolar disorder. The mechanism of action involves D2 receptor blockade and 5 HT2a antagonism. What type of established drug is this most similar to?

A

risperidone

71
Q

The PMHNP is asked to review a medical malpractice case for merit. Which elements must be present to substantiate a claim of negligence?

A

Duty to care, breach of a standard of care, injury related to the breach of the standard of care

72
Q

According to the ANA, which of the following is aimed at reducing human error and creating an open and fair environment for interprofessional equality and collaboration to promote patient safety?

A

just culture

73
Q

An 88-year-old female is prescribed fluvoxamine for generalized anxiety disorder. Which of the following must the PMHNP consider?

A

Drugs are metabolized more slowly through the liver

74
Q

According to the License, Accreditation, Certification, and Education (LACE) Consensus Model for Advanced Practice Registered Nurse Regulation, which of the following statements is true?

A

A licensed board certified PMHNP would be grandfathered into practice and would not need to obtain a doctorate of nursing practice (DNP) degree

75
Q

You are a board certified PMHNP working in a rural critical access hospital-based clinic, and you are doing medication management for a patient with bipolar 2 disorder, who has comorbid hypertension. When checking his blood pressure, you note that the client is hypertensive, and upon further questioning, the client states he has not seen his primary care provider for 9 months because he finds the cost of the visit and the medication prohibitive. The patient would like you to refill his antihypertensive medication. What is the most appropriate action?

A

Call the patient’s primary care provider to explain the situation, and coordinate an appointment and plan for medication refills

76
Q

249A physician is admitted to the hospital and requires an appendectomy. He is medically stable and would like to try conservative management with IV antibiotics. The surgeon consults psychiatry to see if the patient is competent to refuse care. Which of the following is the best response given the scope of practice of the PMHNP?

A

Call the consulting physician and explain that competence is a legal designation, and assess the patient for the capacity to refuse care

77
Q

A nonprofit organization would like to develop a vaccination program, but the grant that will provide the funding requires the project leader to have a doctoral degree, and they have selected a PMHNP on the faculty at a local university to lead this project. Which prevention category are vaccination programs?

A

primary

78
Q

A PMHNP is opening a private practice and decided to offer free screening for depression in her local church during their annual health fair. Which prevention category is testing for disease?

A

secondary

79
Q

goal of reducing recidivism through medication compliance and administering long-acting injectable medications.

A

tertiary

80
Q

What is the process by which the PMHNP identifies signs and symptoms of mental illness and develops an appropriate treatment plan?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 250). Springer Publishing Company. Kindle Edition.

A

Interdisciplinary treatment planning

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 250). Springer Publishing Company. Kindle Edition.

81
Q

251A PMHNP on a disaster response team is deployed to a mass casualty in the immediate aftermath of a school shooting. Which of the following is the priority crisis intervention assessment?

A

Immediate safety of people involved

82
Q

A 50-year-old female presents for care with a chief complaint of cyclical mood swings. She reports that she can sleep through the night except sometimes she awakens to find herself in a pool of sweat. The symptoms began gradually about 5 months ago. She has no other symptoms. What is the most likely diagnosis?

A

menopause

83
Q

When starting the patient on lithium for bipolar disorder, which of the following tests should be done at baseline?

A

renal function

84
Q

253The patient has been on lithium for 6 months and has had a level of 0.8. What other tests should be done?

A

thyroid function

85
Q

A patient who has been on valproic acid for management of his mood disorder develops altered mental status and asterixis. What tests should be done?

A

liver function and ammonia level

86
Q

A 62-year-old female is recently diagnosed with obsessive compulsive disorder. Which of the following symptoms are characteristic of the obsession?

A

anxiety

87
Q

What class of medication is commonly used to treat obsessive compulsive disorder in high doses of monotherapy?

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 253). Springer Publishing Company. Kindle Edition.

A

SSRI

88
Q

APRN practice is regulated by the

.

A

state nurse practice act

89
Q

In evaluating a patient with major depressive disorder, the PMHNP draws a thyroid stimulating hormone (TSH) level which is found to be elevated. This finding is consistent with which of the following?

A

hypothyroidism

90
Q

The purpose of licensure for the PMHNP is to:

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 255). Springer Publishing Company. Kindle Edition.

A

Ensure a minimum level of competency

Zakhari, Raymond, DNP, EdM, ANP-BC, FNP-BC, PMHNP-BC. The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (p. 255). Springer Publishing Company. Kindle Edition.

91
Q

A patient with PTSD reports middle insomnia secondary to nightmares. Which pharmacological class is used specifically to treat this symptom?

A

Alpha blockers

92
Q

A 36-year-old investment banker has been experiencing chest tightness, palpitations, and diaphoresis. He has had these symptoms three times in the last 3 months. Each time he calls 911 and gets admitted to rule out myocardial infarction findings are unremarkable. What is the most likely diagnosis?

A

panic disorder

781 Dipiazza (2 decks)

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