To Prepare
- Reflect on your practice exam question results from Week 2. Identify content-area strengths and opportunities for improvement.
- Also reflect on your overall test taking. Was the length of time allotted comfortable, or did you run out of time? Did a particular question format prove difficult?
The Assignment
- Based on your practice test question results, and considering the national certification exam, summarize your strengths and opportunities for improvement. Note: Your grade for this Assignment will not be derived from your test results but from your self-reflection and study plan.
- Create a study plan for this quarter to prepare for the certification exam, including three or four SMART goals and the tasks you need to complete to accomplish each goal. Include a timetable for accomplishing them and a description of how you will measure your progress. Nursing homework help
- Describe resources you would use to accomplish your goals and tasks, such as ways to participate in a study group or review course, mnemonics and other mental strategies, and print or online resources you could use to study.
| Based on your practice test question results and considering the national certification exam, summarize your strengths and opportunities for improvement. |
23 (23%) – 25 (25%)
The response provides an accurate, clear, and complete summary of both the strengths and opportunities for improvement. |
20 (20%) – 22 (22%)
The response provides an accurate summary of both the strengths and opportunities for improvement. |
18 (18%) – 19 (19%)
The response provides a somewhat vague and/or inaccurate summary of both the strengths and opportunities for improvement. |
0 (0%) – 17 (17%)
A summary of both the strengths and opportunities for improvement are incomplete or missing. |
| Create a study plan, including three or four SMART goals and the tasks you need to complete to accomplish each goal. Include a timetable for accomplishing them and a description of how you will measure your progress. |
27 (27%) – 30 (30%)
The response provides three or four clear and appropriate SMART goals for the study plan, including tasks to complete to accomplish each goal. A clear timeline is provided for the study plan as well as a description of how progress toward goal completion will be measured. |
24 (24%) – 26 (26%)
The response provides three or four appropriate SMART goals and objectives for the practicum experience. Appropriate tasks, timeline, and description of how progress will be measured are provided. |
21 (21%) – 23 (23%)
The response provides three or four somewhat vague or general goals for the study plan. Tasks, timeline, and description of how progress toward goals will be measured are vague or somewhat inappropriate. |
0 (0%) – 20 (20%)
The response provides three or four unclear or inappropriate goals for the study plan, or goals are missing. Tasks, timeline, and a description for how progress will be measured are incomplete or missing. |
| Describe resources you would use to accomplish your goals and tasks, such as ways to participate in a study group or review course, mnemonics and other mental strategies, and print or online resources you could use to study. |
27 (27%) – 30 (30%)
The response provides a clear description of appropriate resources to support the study plan that are tailored to individual need. |
24 (24%) – 26 (26%)
The response provides a description of appropriate resources to support the study plan that are somewhat tailored to individual need. |
21 (21%) – 23 (23%)
The response provides a description of general resources that are not tailored to individual need. |
0 (0%) – 20 (20%)
The response provides a description of inappropriate resources to support the study plan, or the description of resources is vague or missing. |
| Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. |
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. |
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
Purpose, introduction, and conclusion of the assignment are vague or off topic. |
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time.
Purpose statement, introduction, and conclusion were not provided. |
| Written Expression and Formatting – English Writing Standards:
Correct grammar, mechanics, and proper punctuation |
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors |
4 (4%) – 4 (4%)
Contains one or two grammar, spelling, and punctuation errors |
3.5 (3.5%) – 3.5 (3.5%)
Contains several (three or four) grammar, spelling, and punctuation errors |
0 (0%) – 3 (3%)
Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding |
| Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/narrative in-text citations, and reference list. |
5 (5%) – 5 (5%)
Uses correct APA format with no errors |
4 (4%) – 4 (4%)
Contains one or two APA format errors |
3.5 (3.5%) – 3.5 (3.5%)
Contains several (three or four) APA format errors |
0 (0%) – 3 (3%)
Contains many (five or more) APA format errors |
| Total Points: 100 |
To Prepare
Reflect on your practice exam question results from Week 2. Identify content-area strengths and opportunities for improvement.
Also reflect on your overall test taking. Was the length of time allotted comfortable, or did you run out of time? Did a particular question format prove difficult?
The Assignment
Based on your practice test question results, and considering the national certification exam, summarize your strengths and opportunities for improvement. Note: Your grade for this Assignment will not be derived from your test results but from your self-reflection and study plan.
Create a study plan for this quarter to prepare for the certification exam, including three or four SMART goals and the tasks you need to complete to accomplish each goal. Include a timetable for accomplishing them and a description of how you will measure your progress. Nursing homework help
Describe resources you would use to accomplish your goals and tasks, such as ways to participate in a study group or review course, mnemonics and other mental strategies, and print or online resources you could use to study.
PRACTICE TEST
QUESTIONS
- A 42-year-old male with alcohol use disorder for 5 years is referred to
the PMHNP from his primary care provider for addiction treatment.
Which of the following laboratory findings would be consistent with
his diagnosis?
- Increased urine and serum creatinine levels
- Increased mean corpuscular volume and triglycerides
- Increased potassium and chloride levels
- Decreased mean corpuscular volume and normal triglyceride level
- A 9-year-old girl with a history of generalized anxiety disorder has been
stable on fluoxetine 10 mg for 6 months and presents for follow-up
complaining of bilateral leg pain. The physical exam, complete blood
count, and metabolic profile are normal except for an elevated alkaline
phosphatase. The PMHNP understands that this finding is:
- Consistent with liver disease
- Abnormal and should be repeated immediately
- Abnormal and requires further evaluation of autoimmune hepatitis
- A commonly occurring pre-puberty finding known as growing
pains
- 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
- Dysthymia
- Major depression
- Generalized anxiety disorder
- Seasonal affective disorder
- The purpose of a professional organization’s scope and standards of
practice is to:
- Define the roles and actions for that particular profession
- Define the differences between professions
- Establish the legal authority to practice for a profession
- Define the legal statutes that are governing a profession
- 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 skills class for at risk adolescents
- A suicide hotline
- Mandated treatment
- A psychosocial clubhouse for the mentally ill
- Which of the following is representative of legal ruling trends over the
past 30 years?
- Juries have been encouraged to find defendants not guilty because
of insanity
- People with mental illness retain their inalienable rights even when
committed to a mental hospital
- Courts place increased trust in the professional judgment of mental
healthcare providers to make ethical decisions
- The time in bringing cases before a magistrate for commitment
hearings has been reduced
- A patient who has been voluntarily committed is experienc2i3n6g
symptoms of psychosis; he declares he has the right to refuse his
medications despite the court order because God told him he would be
healed by his faith alone. Based on your knowledge of court-ordered
treatment, which of the following statements is true? Nursing homework help
- Psychiatric clients cannot refuse treatment
- Psychiatric clients can refuse treatment unless it is court ordered
- Psychiatric clients cannot act in their own best judgment
- The professional judgment of the PMHNP supersedes the client’s
right to refuse medication
- Which of the following elements is reflective of a professional
relationship rather than a social relationship?
- In a professional relationship, there is no place for social
interactions
- In a professional relationship, the PMHNP is solely responsible for
making the relationship work
- In a professional relationship, the primary focus is on the client
and their needs
- In a professional relationship, goals are left vague so that the client
feels any issue can be discussed
- 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?
- Tertiary prevention
- Secondary prevention
- Solution-focused prevention
- Primary prevention
237
- A 45-year-old White female agreed to hospitalization after presenting to
the emergency department with passive suicidal ideations. After 24
hours she states that she wishes to leave because “this place cannot
help me.” Which of the following actions reflects the legal right of the
client?
- The patient should be discharged immediately
- The patient is discharged after she signs forms indicating her
actions and acknowledging her actions are against medical advice
- Contact a collaborating physician to convert the patient to an
involuntary status
- Explain that the patient cannot leave until further assessments are
completed and collateral information is obtained
- The PMHNP is aware that the essentials of the therapeutic alliance
include all of the following except:
- Formulating a differential diagnosis
- Genuineness
- Acceptance
- Authenticity
- 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?
- Acute stress reaction
- Reaction formation
- A normal resistance seen in the termination time of therapy
- A sign of undiagnosed pathological attachment
- A 30-year-old man reports low self-esteem, demonstrates poor selfcontrol, exhibits much self-doubt, and requires a high degree of
reassurance. What developmental task has he failed to master?
- Trust versus mistrust
- Industry versus inferiority
- Generativity versus stagnation
- Integrity versus despair
- A 25-year-old male has been seeing his psychoanalyst four times a week
for the last year and is bothered by recent episodes of forgetfulness
including misplacing everyday items and missing appointments. Nursing homework help
Which Freudian psychodynamic principle assumes all behavior
conveys purpose?
- The Ego development principle
- Psychic determinism principle
- The Id principle
- The Superego mediation principle
- Which of the following is an example of a mature defense mechanism?
- Projection
- Repression
- Altruism
- Regression
- A Black man in the fifth decade of life has been seen for several weeks
of psychotherapy to discuss his current stressors. He proceeds to curl
up in the fetal position and lie on the floor. Which defense mechanism
is he manifesting?
- Repression
- Projection
- Denial
- Regression
- 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?
238
- Past medical and psychiatric history
- Hemodynamic stability
- The current level of suicidality
- Effective coping mechanisms
- For which of the following reasons are selective serotonin reuptake
inhibitors (SSRIs) considered the first-line drug of choice for
depression without psychotic features?
- Ease of dosing for step-wise titration
- Promote sleep
- Difficulty in overdosing for suicidal patients
- Drug level monitoring capabilities
- A man diagnosed with major depressive disorder is started on a selective
serotonin reuptake inhibitor (SSRI). Which of the following ways is
most effective for the PMHNP to monitor the client’s response to
medication?
- An EKG for QTc prolongation
- Basic metabolic profile
- Urine toxicology screen
- A standardized rating scale for depression
- The following statement is reflective of which type of therapy: “If a
miracle were to happen and all of your symptoms that brought you into
therapy no longer existed, what would be different?”
- Cognitive behavioral therapy
- Dialectical behavioral therapy
- Solution-focused therapy
- Psychoanalysis
- According to family systems theory, which of the following is
reflective of homeostasis?
- Family members placate each other to keep the peace
- Family members behave erratically to reduce predictability
- Stability in the interpersonal relationships despite dysfunctions
- A crisis restores peace
- A married couple of 7 years presents for therapy because the wife
perceives her husband to be a constant nag. He believes that he is
correct and only trying to help. You assign him a paradoxical directive
to schedule 1 hour per day in which he nags her, and once that hour is
over to keep a list and save it until the next day. The PMHNP
recognizes this type of therapy as:
- Experiential therapy
- Strategic therapy
- Structural therapy
- Solution-focused therapy
- Which of the following is an essential principle of cognitive behavioral
therapy?
- Recognizing and accepting automatic thoughts
- Recognizing and changing automatic thoughts
- Seeing reality as the private provider sees it
- Changing reality through environmental restructuring
- Which of the following principles of group dynamics enhances
therapeutic efficacy?
- Cost efficiency
- Acquiring curative factors
- Enhancing social skills
- All of the above
- The patient is referred by his primary care physician for the treatment of
panic disorder with agoraphobia. He had been titrated on paroxetine
CR 37.5 mg daily and clonazepam 0.5 mg daily as needed. He has
been on this regimen for the last year, but he admits that he sometimes
requires as many as five clonazepam tablets to get the same effect.
Which pharmacokinetic property is influencing this phenomenon?
- Potency
239
- Tolerance
- Kindling
- Addiction
- The process by which the body affects the drug is known as:
- Metabolism
- Distribution
- Pharmacokinetics
- Pharmacodynamics
- Which of the following neuroleptic mood stabilizing medications
commonly used to treat bipolar disorder is associated with which
teratogenic effects?
- Divalproex (shortened limbs); lithium (seizure disorder)
- Lithium (Ebstein’s anomaly); divalproex (neural tube defects)
- Divalproex (Ebstein’s anomaly); lithium (cleft lip and palate)
- Lithium (spina bifida); divalproex (neural tube defects
- Which of the following conditions that occur with the aging process
affects drug metabolism?
- Increased muscle mass
- Reduced protein binding
- Increased liver metabolization pathways leading to toxicity
- Decreased body fat
- Which of the following classes of medications is thought to exacerbate
or cause depression?
- Proton pump inhibitors
- Beta blockers
- Antihistamines
- PD 5 inhibitors
- 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?
- Increase his antidepressant medication
- Augment his selective serotonin reuptake inhibitor (SSRI) with a
partial agonist antipsychotic
- Order blood work to evaluate his renal function and electrolytes
- Order a 12-lead EKG
- 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?
- Ask the patient how to help her
- Provide teaching about the long timeframe it takes for tricyclic
antidepressants (TCAs) to work
- Contract with the patient for six sessions of therapy
- Tell the patient how suicide might affect her family
- 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
- “Everybody loves you and likes being around you”
- “Tell me what you mean when you say ‘life is not worth living’”
- Therapeutic use of silence
- “Are you thinking suicide might be an option for you?”
- During the first session of therapy, the patient makes the following
statement: “All my other kids got through their drug use phase and
were able to get on with their lives. I have grounded him, taken away
his privileges, and I even tried to cut out his allowance, but I’m just not
sure what I should do now?” What is the most therapeutic response for
the PMHNP to make?
240
- Therapeutic use of silence
- “I wonder if locking him in his room was abusive.”
- “Maybe that depends on what you’re trying to accomplish.”
- “Perhaps talking to his friends, coaches, and teachers would be
helpful.”
- While performing a mental status exam on a patient, you ask them to
interpret this proverb: “A stitch in time saves nine.” The patient replies
“The garment would be more likely to rip.” How would you interpret
these findings?
- The patient is psychotic
- The patient is anxious
- The patient is intellectually disabled
- There is not enough information to interpret the statement without
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knowing the client’s age
- A 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?Nursing homework help
- Reflecting
- Restating
- Presenting reality
- Validating
- The PMHNP will evaluate a recently admitted 22-year-old male and
formulate the initial treatment plan. The patient asks to go to his room
because “people make me nervous.” The PMHNP’s action should be
based on the awareness that the best location to do an initial evaluation
is:
- In the patient’s room because it’s the least noisy and most
comfortable for him
- In a public area to observe his interactions with others
- In a treatment room with the door closed in a neutral location
- In a quiet but public place to get assistance should it be required
during the evaluation
- What is the primary goal of a comprehensive psychiatric evaluation?
- To complete the necessary forms for a maximum reimbursement
- To develop a correct diagnosis
- To communicate with others about the patient’s healthcare needs
- To identify the mental health needs of the patient
- Psychotropic medications are used to treat
- Psychiatric disorders
- Psychiatric symptoms
- Neurological conditions
- Endocrine disorders
- 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?
- Parietal lobe
- Frontal lobe
- Temporal lobe
- Occipital lobe
- Which of the following neurotransmitters is excitatory?
- Gamma-aminobenzoic acid (GABA)
- Dopamine
- Norepinephrine
- Glutamate
- Which of the following is a contraindication for brain MRI?
- Automated internal cardiac defibrillator (AICD)/pacemaker
- History of traumatic brain injury
241
- Hip replacement
- Pregnancy
- Which area of the brain regulates appetite, the sleep-wake cycle, and
libido?
- Hippocampus
- Amygdala
- Hypothalamus
- Limbic system
- Which of the following areas of the brain produces dopamine?
- Substantia nigra
- Raphe nuclei
- Locus ceruleus
- Basal nucleus
- What purpose does a neurotransmitter serve in the nervous system?
- Enzyme breakdown
- Amino acid scaffolding
- Communication medium
- Enzyme production
- A patient who was able to escape the World Trade Center during 9/11 is
dysphoric several months after the event and tells the PMHNP that she
does not want to talk about her coworkers who were lost because it
hurts so much. Which defense mechanism is being utilized?
- Denial
- Suppression
- Undoing
- Projection
- A patient who is unable to recall his involvement in a psychological
trauma is using which of the following defense mechanisms?
- Denial
- Suppression
- Deep depression
- Undoing
- 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?
- Suppression
- Denial
- Repression
- Sublimation
- A man finds his coworkers exceptionally difficult to work with, and he
finds them generally incompetent. He does not share his thoughts with
his coworkers or his boss out of fear of hurting their feelings. He
suddenly has the urge to bring baked goods several times a week.
Which defense mechanism is the best explanation for this behavior?
- Denial
- Suppression
- Repression
- Undoing
- Which of the following is a defense mechanism purpose?
- Alert to danger
- Protect the Id
- Resolve conflicts
- Suppress intuition
- Which of the following is the best intervention for a client experiencing
ataque de nervios?
- Benzodiazepines
- Using a family member to interpret
- Involuntary admission
242
- Referral to supportive psychotherapy by a therapist who speaks the
language
- Which of the following ADHD symptoms overlap with PTSD in
children and adolescents?
- Talkativeness, hyperactivity, distractibility
- Avoidance behaviors, mood lability, irritability
- Recklessness, hypervigilance, aggressiveness
- Disorganization, interrupting, carelessness
- A 17-year-old male, high school senior who is on the wrestling team, is
being treated for an eating disorder. He is of average weight, socially
engaged, and attention seeking at times among his peers. Which of the
following eating disorders is most consistent with these symptoms?
- Anxiety-induced eating disorder
- Binge eating disorder
- Bulimia nervosa
- Anorexia nervosa
- His two fathers bring a hyperactive 7-year-old boy for follow-up
treatment of attention deficit hyperactivity disorder. Also on this visit
is the newest addition to the family, an 8-month-old baby boy. The
PMHNP notices that this child has a small head along with stereotypic
motions of the hands, slapping and licking behaviors, and is seemingly
regressed. Language skills are also more primitive than expected.
What medical condition does the PMHNP suspect the 8-month-old
baby boy has developed?
- Autism spectrum disorder
- Rett syndrome
- Selective mutism
- Progeria
- A PMHNP is about to start an 8-year-old girl on a stimulant for attention
deficit hyperactivity disorder (ADHD). Your clinical observations and
rating scales corroborate the diagnosis. What assessments need to be
completed before starting stimulant medication?
243
- The ADHD rating scale completed by the grandparents
- Rule out a family history of bipolar disorder
- Check blood pressure and pulse
- Blood pressure, pulse, height, weight, and 12-lead EKG
- Many psychotropic medications come with a black box warning,
particularly for use in children and young adults. What specific
education must you provide to a 22-year-old male as the PMHNP to
the patient?
- Risk of increased impulsive behavior
- Risk of increased suicidal thoughts
- Risk of sexual side effects
- Risk of teratogenic sperm production
- According to the DSM-5, personality disorders are categorized according
to which of the following?
- Axis II
- Axis III
- Axis IV
- The primary psychiatric disorder
- Which of the following is NOT an example of the defense mechanism of
isolation, as may be exhibited by someone with a Cluster C personality
disorder?
- Not leaving the house for many days
- Declining invitations for social events
- Remaining private and introverted in the workplace to avoid
coworkers
- Expressing detailed information without flat affect
- Which of the following is considered a genetic and social risk factor
for a person to develop antisocial personality disorder?
- Psychotic disorders
- Oppositional defiant disorder
- Generalized anxiety disorders
- Affective disorders
- A 35-year-old female with a Cluster A personality disorder states that “I
hear people outside the office door during our sessions. Are they
listening in on us?” What would be your best response?
- Validate her, and ask her to tell of a time in her life when she had a
similar experience
- Using humor, ask a rhetorical question to stimulate reflection and
then reassure her that she is that special
- Distract her from the topic and insist that there is no way for
someone outside to hear your session
- Validate her, and inform her that the white noise sound machine
muffles the sounds of the session and it would be hard to hear the
conversation outside the office
- In speaking with a 50-year-old man with a Cluster A personality
disorder, which would be the best strategy?
- Do not challenge his negative views or recollections of past events
- Confront misinterpreted thoughts and feelings, especially those
that are negative
- Make time for a detailed and emotionally engaging dialogue
- Deflate any grandiose thoughts he may have
- Which of the following personality disorders are classified as Cluster A?
- Paranoid personality disorder, schizoid personality disorder,
schizotypal personality disorder
- Antisocial personality disorder, borderline personality disorder,
histrionic personality disorder, narcissistic personality disorder
- Avoidant personality disorder, dependent personality disorder,
obsessive compulsive personality disorder
- Paranoid personality disorder, antisocial personality disorder,
obsessive compulsive personality disorder, histrionic personality
disorder
244
- Which of the following personality disorders are classified as Cluster B?
- Paranoid personality disorder, schizoid personality disorder,
schizotypal personality disorder
- Antisocial personality disorder, borderline personality disorder,
histrionic personality disorder, narcissistic personality disorder
- Avoidant personality disorder, dependent personality disorder,
obsessive compulsive personality disorder
- Paranoid personality disorder, antisocial personality disorder,
obsessive compulsive personality disorder, histrionic personality
disorder
- Which of the following personality disorders are classified as Cluster C?
- Paranoid personality disorder, schizoid personality disorder,
schizotypal personality disorder
- Antisocial personality disorder, borderline personality disorder,
histrionic personality disorder, narcissistic personality disorder
- Avoidant personality disorder, dependent personality disorder,
obsessive compulsive personality disorder
- Paranoid personality disorder, antisocial personality disorder,
obsessive compulsive personality disorder, histrionic personality
disorder
- What is the primary goal of psychotherapy and treating someone with a
personality disorder?
- Enhance the client’s ego strength and encourage the use of mature
defense mechanisms
- Review the antecedents to this pathological personality
development, paying particular attention to trauma
- Help parents and the client to form secure attachments
- Make the client change their personality so that they’re more
adaptable in everyday life
- In working with a 34-year-old man initially seen for substance use
disorder who continues in therapy to develop effective coping
through the use of mature defense mechanisms, the patient states “I
noticed your Rolex watch, is that new? You have exquisite taste.”
What is the best response from the psychiatric mental health nurse
practitioner?
- “You’re right, I do.”
- “I didn’t realize you paid such close attention to what I wear.”
- “I noticed you had a Rolex watch as well. How do you like it?”
- “It sounds like you value luxury items. Tell me more about that.”
- Which of the following defense mechanisms are most commonly used in
patients with Cluster C personality disorders?
- Displacement and reaction formation
- Motivation and disassociation
- Projection and distortion
- Isolation and intellectualization
- When asking an adolescent male about his cannabis use disorder, which
of the following signs or symptoms would you expect him to report?
- Enhanced motor skills
- Accelerated time passage
- Heightened sensitivity to external stimuli
- Lower heart rate
- The PMHNP sees a 34-year-old male 2 weeks after an opioid detox. The
patient states “I feel like I’m going to die if I don’t get something to
relieve my symptoms.” What would be the best response? Nursing homework help
- “This feeling will pass, you just have to tolerate the discomfort for
the short term.”
- “Let me check your vital signs to see if you would be able to
tolerate a clonidine patch.”
- “You have been using OxyContin for a long time, and it will take
several months for the withdrawal to end. In the meantime I should see
you twice a week.”
245
- “You are no longer in withdrawal as it has been 14 days since your
last use and your urine tox screen is clean.”
- An RN from the detox unit reports to you that a 54-year-old man who
was admitted 3 days ago for alcohol use disorder has a Clinical
Institute Withdrawal Assessment (CIWA)-Alcohol score of 20. How
severe are his symptoms?
- Severe withdrawal
- Moderate withdrawal
- Mild withdrawal
- Delirium tremens
For Questions 70 and 71, use the following scenario:
- During your session with a 17-year-old male with cannabis use disorder,
who engages in petty theft, and has refused school since 7th grade, the
patient makes the following statement: “I don’t know why I continue
to see you, you just charge my parents so much money, and all I want
to do is feel good.” The PMHNP replies, “You feel confused about the
process.” To which the boy replies, “I never thought I’d have a shrink
come to my house.” You then reply, “Thank you for allowing me into
your home, and I recognize the courage it must have taken to allow
this to happen.” A typical counseling technique used by PMHNPs is
motivational interviewing. What are techniques from motivational
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interviewing in this dialogue?
- Affirming and reflecting
- Interrupting and reassuring
- Open-ended questions and summarizing
- Clarification and data collection
- According to Prochaska’s transtheoretical model, which stage of
change is the patient in Question 70 in?
- Precontemplation
- Contemplation
- Preparing to take action
- Taking action
- One of the most common problems encountered by a PMHNP on the
consultation liaison (CL) service is delirium. Why must the CL
maintain a high index of suspicion for this condition?
- High risk of a 1-year mortality rate
- High risk for depression
- High risk for self-harm and harm to others
- High risk for persistent psychosis
- Which of the following is the best treatment for AIDS-related complex
dementia?
- Anti-Parkinson agents
- Nonpharmacological supportive care
- Antiretroviral therapy
- Acetylcholinesterase inhibitors
- A PMHNP is contracted to a student health clinic to work with incoming
freshman and transfer students for several weeks. The PMHNP
encounters a student who describes himself as shy and uncomfortable
in social situations. He reports having few friends in high school and
has realized that he needs a few drinks to loosen up before going out to
party. Upon further questioning, it is revealed he consistently drinks
two to three beers on the weekend to enhance his socialization.
According to the DSM-5, does this student have a mental illness?
- Yes, mild alcohol use disorder
- No, the student does not meet the criteria for mental illness
- Yes, adjustment disorder with mixed features
- Yes, social anxiety disorder
- 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?
- “You seem ambivalent about seeking treatment.”
- “It’s obvious you don’t want to come for treatment.”
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- “You knew you would have to be charged for missed
appointments.”
- “Help me understand what’s going on so we can figure out how to
proceed.”
- A 42-year-old White female presents with concerns about her memory.
She states that her grandmother experienced Alzheimer’s dementia and
that her 63-year-old mother with obesity, hypertension, and depression
is also increasingly forgetful. The patient wants to do everything
possible to prevent or significantly postpone the onset of dementia.
She currently works full time, is the mother of two children, is
president of the PTA, attends church regularly, exercises three to four
times a week, volunteers for various organizations, and is sexually
active with her husband of 10 years. She occasionally forgets dates and
misplaces things. What is the best response to this patient?
- “Continue your regular activities but be careful of the exercise,
less because of injury to self but because a prolonged hospitalization
and loss of independence would increase your risk for dementia.”
- “We can start you on some fish oils, vitamin E supplements, and
medication to enhance your memory.”
- “While most brain development occurs early in life, we still form
new brain cells in various areas of the brain throughout our lives.
Continue with your activities because they offer the best protection of
cognitive function.”
- “Researchers know that we do continue to form new brain cells
throughout the entire brain during adulthood. Keep up with your
activities because you are producing new brain cells in the frontal lobe
and this will decrease your risk of dementia.”
- David 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?
- Benzodiazepines cause memory problems and confusion in clients
with a history of traumatic brain injury
- Benzodiazepines increase the risk of a subsequent traumatic brain
injury
- Benzodiazepines are addictive, and therefore banned from the VA
formulary
- Benzodiazepines lower the seizure threshold particularly in clients
with traumatic brain injury
- A 23-year-old male with schizoaffective disorder and a history of four
past hospitalizations for manic episodes has been started on clozapine.
During the weekly complete blood count with differential, which of the
following results would necessitate discontinuing treatment?
- Absolute neutrophil count (ANC) less than 2,000
- Leukocytes less than 5,000
- ANC less than 1,000
- Leukocytes less than 2,000 and ANC less than 1,200
- 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?
- Risperidone
- Haloperidol
- Chlorpromazine
- Thiothixene
- Which of the following hallucinations is more common in patients with
an organic etiology such as substance-induced altered mental status or
delirium rather than in patients with psychosis such as schizophrenia,
schizophreniform disorder, and brief psychotic episode?
- Tactile hallucinations
- Auditory hallucinations
- Visual hallucinations
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- Combined hallucinations
- Which of the following best summarizes the evidence-based practice
guidelines regarding the initiation of antipsychotic medication?
- Physical exam to include blood glucose, lipid profile, height and
weight, blood pressure, waist circumference, and a review of
cardiovascular risk factors and the family history
- Physical exam to include a comprehensive metabolic panel, body
mass index, complete blood count, and thyroid function
- Serum glucose or hemoglobin A1C, lipid profile, weight, body
mass index, blood pressure, waist circumference, and review of family
cardiovascular disease
- Serum glucose, complete blood count, assessment of family
history regarding cardiovascular disease, and cancer
- A 59-year-old man has been seeing the PMHNP for schizophrenia. He
was first diagnosed when he was 21 years old. He remains medication
compliant. In getting to know the patient, it is revealed that he has very
few social interactions, prefers to be alone, and has never had a
romantic interest or desire to pursue one. Which type of symptoms is
pervasive in this clinical presentation?
- Affective disorder
- Positive symptoms
- Negative symptoms
- Self-care deficit
- A 33-year-old married gay man employed as a corporate attorney
wonders aloud to the PMHNP: “Things are going well in our
relationship, our 8-year-old boy is about to enter third grade, our 6-
year-old girl is entering 1
first grade; my husband is a successful
published author, but for some reason I don’t feel happy. I think I have
been depressed for much of my life.” From a transactional analytic
(TA) perspective, the PMHNP understands that many factors affect
personality. Which of the following demonstrates a core concept in
TA?
- “Do you recall long periods of separation from your mother or
father as a child which may be affecting your ability to accept love and
experience happiness?”
- “During your adolescence have you experienced any events that
forced you into a parentified role?”
- The patient has a distorted thought pattern affecting interpersonal
relationships.
- The patient likely had a traumatic event in his childhood in which
thoughts and feelings have become locked together and are
inaccessible to the conscious mind.
- Dialectical behavioral therapy (DBT) therapy involves reconciling the
tension to find the truth between:
- Experience and avoidance
- Radical acceptance and change
- Crisis survival and radical acceptance
- Confrontation and avoidance
- In conducting a risk-benefit analysis regarding healthcare resource
utilization in the planning of a psychosocial clubhouse for an at-risk
population, what are two economic concepts that must be considered
in allocating public funds to demonstrate a return on investment and
access to care with the greatest number of people?
- Affordability and quality
- Equity and efficiency
- Cost and benefits
- Opportunities and risks
- The PMHNP is asked to review a medical malpractice case for merit.
Which elements must be present to substantiate a claim of negligence?
- Deceit, breach of standards of care, and intent to harm
- Breach of care, violation of ethics, patient abandonment
- Beneficence, nonmaleficence, veracity, breach of standards
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- Duty to care, breach of a standard of care, injury related to the
breach of the standard of care
- According to the American Nurses Association position statement, 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?
- Just culture
- Personnel policies and HIV in the workplace
- Standardization of health information technology
- Civil disobedience
- An 88-year-old female is prescribed fluvoxamine for generalized anxiety
disorder. Which of the following must the PMHNP consider?
- Drugs are metabolized more slowly through the liver
- Treatment is shorter in duration
- The therapeutic dose is higher than for children
- Titration should be faster to delay first pass effects
- A 36-year-old female reports increasing fatigue, decreased energy,
difficulty concentrating, sleepiness through the day, and anhedonia.
The most bothersome symptom was the impaired concentration. She
was started on venlafaxine 37.5 mg once daily 1 week ago by her
primary care provider until she was able to see the PMHNP. During
your evaluation, you note pressured speech to the point where she is
uninterruptible at times, her affect is expansive, she continues to report
difficulty sleeping but states her energy is terrific, and she can “get so
much done.” Which of the following is a plausible explanation for this
clinical presentation?
- She is psychotic
- She has become euthymic
- She is hypomanic
- These are adverse effects of venlafaxine
- A middle-aged married man was referred to you for management of his
depression. His symptoms include fatigue throughout the day, leading
him to drink five to six cups of coffee daily to stay awake; this leads to
him feeling too wired to sleep at night. He drinks one to two drinks
every night. He has no trouble falling asleep. However, his wife kicks
him due to his snoring and describes him as a restless sleeper, and he
also sweats profusely every night. Which of the following is the most
likely cause of his middle insomnia?
- Attention deficit disorder which he is medicating with caffeine
- Alcohol withdrawal syndrome
- Caffeine use disorder
- Obstructive sleep apnea
- 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 licensed board certified PMHNP would be grandfathered into
practice and would not need to obtain a doctorate of nursing practice
(DNP) degree
- The PMHNP will not be able to continue practicing after 2025
- The PMHNP will have to take a doctoral level board exam to be
able to keep practicing after 2025
- The PMHNP without a DNP will be required to have a
collaborating physician after 2025, even if they are in a full practice
authority state
- 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?
- Call the pharmacy to confirm the medication and dosage and order
a refill for 1 month until the patient can see his primary care provider
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- Advise the patient to go to the emergency department if any signs
and symptoms develop
- Send the patient to urgent care for evaluation and refill of the
antihypertensive medication
- Call the patient’s primary care provider to explain the situation,
and coordinate an appointment and plan for medication refills
- A PMHNP is attending a post-master’s doctorate of nursing practice
(DNP) program, and for his capstone project, he would like to see how
many patients discharged from inpatient psychiatry are seen for follow
up within 7 days and devise a system to ensure this standard is
consistently met. What type of evidence-based project is this?
- Quality improvement
- Research proposal
- Needs assessment survey
- Dissertation
- A 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?
- Refer the case to a psychiatrist because this is outside the scope of
practice for PMHNPs
- Complete the assessment and write an attestation to the patient’s
competence
- Call the consulting physician and explain that competence is a
legal designation, and assess the patient for the capacity to refuse care
- Refer the case to the hospital general counsel so that the patient
can have a competency designation
- 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?
- Preventive care
- Primary prevention
- Secondary prevention
- Tertiary prevention
- 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?
- Primary prevention
- Secondary prevention
- Tertiary prevention
- Preventive care
- A PMHNP would like to expand her revenue streams for her private
practice. She decides to start a concierge model specifically targeting
those who are recently discharged from the hospital after their first
manic episode or with a diagnosis of bipolar disorder with the goal of
reducing recidivism through medication compliance and administering
long-acting injectable medications. This service is an example of
which kind of prevention strategy?
- Primary prevention
- Secondary prevention
- Tertiary prevention
- Acute treatment
- Which ethical principle supports an individual’s right to choose to accept
or refuse care despite medical advice?
- Beneficence
- Justice
- Nonmaleficence
- Autonomy
- Which cranial nerve is the PMHNP examining when the patient is asked
to stick out their tongue?
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- II-optic nerve
- III-oculomotor nerve
- X-vagus nerve
- XII-hypoglossal nerve
- The PMHNP is working in a movement disorders clinic due to the
incidence of depression and dementia associated with Parkinson’s
disease. The patient is unable to shrug his shoulders. Which cranial
nerve might be affected?
- XII
- XI
- IX
- V
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