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Quiz Session - Attempts With Random Questions

AANPCB PMHNP-C Exam Questions

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1.

Which moral duty does a nurse practitioner leader uphold by doing what is fair?

  • Justice

  • Veracity

  • Respect

  • Fidelity

Correct answer: Justice 

An important aspect of the nurse practitioner role encompasses the moral duties, obligations, and responsibility of being a leader in health care. Ethical principles that provide the foundation and direction for true leadership include the following:

  • Justice: Doing what is fair
  • Veracity: Telling the truth
  • Respect: Treating everyone with equal dignity
  • Fidelity: Being true and loyal

2.

A 47-year-old man with a history of alcohol use disorder presents to the emergency room. His family tells you that he has been "living off whiskey and nothing else for weeks." The nurse is about to draw his blood and offer him a snack. What is your next immediate action?

  • Administer thiamine

  • Listen for a murmur

  • Order lorazepam (Ativan) to be given as needed for agitation

  • Obtain a vitamin B12 level

Correct answer: Administer thiamine

Individuals with chronic alcohol misuse often consume most of their calories from alcohol and are at high risk for thiamine deficiency. A thiamine-deficient person can develop Wernicke encephalopathy if they attempt to metabolize food. You must administer thiamine immediately for this patient.

The other choices are also important but do not require immediate action.

3.

A psychiatric nurse practitioner is leading a team in a mental health clinic that recently experienced an adverse event involving a medication error. The team is conducting a root cause analysis to determine the underlying cause of the error. What is the primary goal of a root cause analysis in this context?

  • To determine the underlying causes of the medication error and develop strategies to prevent future errors

  • To identify the individual responsible for the medication error

  • To develop a plan to address the immediate consequences of the medication error

  • To report the medication error to the appropriate regulatory agency

Correct answer: To determine the underlying causes of the medication error and develop strategies to prevent future errors

Root cause analysis is a process used to identify the underlying causes of an adverse event, such as a medication error, and to develop strategies to prevent similar events from occurring in the future. The goal of a root cause analysis is to identify the systemic factors that contributed to the event, rather than focusing on individual blame or punishment.

4.

Which of the following is a positive symptom of schizophrenia?

  • Hallucinations

  • Alogia

  • Abstract thinking problems

  • Affective flattening

Correct answer: Hallucinations

Positive symptoms are caused by increased dopamine in the mesolimbic pathway and include hallucinations and delusions.

Negative symptoms—affective flattening, abstract thinking problems, and alogia—are caused by decreased dopamine in the mesocortical pathway.

5.

Which of the following is a differential diagnosis to consider that often mimics panic disorder and symptoms of anxiety?

  • Vestibular dysfunction

  • Hypothyroidism

  • Hypoparathyroidism

  • Hypersomnia

Correct answer: Vestibular dysfunction

The vestibular system includes the parts of the inner ear and brain that help control balance and eye movement. This system, when dysregulated, can mimic symptoms of panic and anxiety.

Hyperthyroidism and hyperparathyroidism are also differential diagnoses to consider. Loss of consciousness is a differential diagnosis to consider for hypersomnia.

6.

A patient with bipolar disorder is experiencing a manic episode and is refusing to be admitted to a hospital for treatment. What should the PMHNP do to ensure that the patient receives the most appropriate and least restrictive care possible when maintaining the patient's safety?

  • Respect the patient's autonomy and provide community-based support

  • Obtain a court order for involuntary commitment

  • Administer medication against the patient's will for the patient's safety

  • Use seclusion and restraint as a form of treatment as the patient is manic and refusing care

Correct answer: Respect the patient's autonomy and provide community-based support

The principle of least restrictive care holds that patients should receive the most appropriate care, limiting their loss of freedom and autonomy to the least degree possible. 

Involuntary commitment, administering medication against the patient's will, or using seclusion or restraint would all be more restrictive forms of treatment that should only be used as a last resort and with proper legal and ethical considerations.

7.

A patient is prescribed memantine to treat moderate to severe Alzheimer's disease. Which of the following medications is frequently prescribed with memantine?

  • It should be used in combination with a cholinesterase inhibitor

  • It should be used as monotherapy

  • It should be used in combination with an antidepressant

  • It should be used in combination with an antipsychotic

Correct answer: It should be used in combination with a cholinesterase inhibitor

Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist that is FDA-approved for the treatment of moderate to severe Alzheimer's disease. It is believed to work by regulating the activity of a neurotransmitter called glutamate, which is involved in learning and memory. The prescribing guidelines for memantine include using it in combination with a cholinesterase inhibitor as it is more effective than monotherapy in treating moderate to severe Alzheimer's disease.

Memantine should not be used as monotherapy. It should not be used in combination with an antidepressant or antipsychotic, as these are not evidence-based treatment options for Alzheimer's disease.

8.

When compared with patients suffering from major depression, a patient experiencing an episode of grief would likely preserve which feature?

  • Self-esteem

  • Changes in cognitive reactions

  • Changes in behavioral reactions

  • Changes in emotional responses

Correct answer: Self-esteem

Unlike in major depression, self-esteem is usually preserved in the grieving person.

A normal grieving response can involve temporary changes in cognitive, behavioral, and emotional reactions/responses. 

9.

Who created the family systems therapy model?

  • Murray Bowen

  • Salvador Minuchin

  • Virginia Satir

  • Jay Haley

Correct answer: Murray Bowen

Murray Bowen believed that a person's problematic behaviors may serve a function or purpose for the family or be a symptom of dysfunctional patterns. The family systems therapy model focuses on chronic anxiety within families.

Salvador Minuchin created the structural family therapy model. Virginia Satir created the experiential therapy model. Jay Haley created the strategic therapy model.

10.

The primary goal in the clinical management of major depressive disorder (MDD) during the acute phase is which of the following? 

  • Client safety

  • Resolution of symptoms

  • Starting medication

  • Starting psychotherapy

Correct answer: Client safety

Client safety is the top management goal during the acute phase of MDD. It may happen concurrently with starting medication and psychotherapy to achieve a resolution of symptoms, but it is the primary goal.

11.

In common psychiatric disorders, which neurotransmitter is implicated in the complex pathophysiology of certain disease processes involving normal functions such as decision-making and integrated cognition?

  • Dopamine

  • Norepinephrine

  • Serotonin

  • Glutamate

Correct answer: Dopamine

The general function of dopamine involves normal functioning of thinking, decision-making, reward-seeking behavior, fine muscle action, and integrated cognition. Dopamine irregularities are closely linked to disease processes such as schizophrenia.

The general function of norepinephrine involves alertness, orientation, fight-or-flight, learning, memory, and focus and attention. Norepinephrine irregularities are closely linked to disease processes such as panic disorders and anxiety.

The general function of serotonin involves the regulation of sleep, pain perception, mood states, temperature, aggression, and libido. Serotonin irregularities are closely linked to depressive disorders.

The general function of glutamate involves memory and sustained autonomic functions. Glutamate irregularities are closely linked to bipolar disorders.

12.

A psychiatric mental health nurse practitioner is providing care for a patient with a history of substance use disorder. The patient expresses interest in making positive changes in their health behaviors. Which health promotion and maintenance model would be most appropriate for the nurse practitioner to consider in this situation?

  • Transtheoretical Model

  • Health Belief Model

  • Social Cognitive Theory

  • Ecological Model

Correct answer: Transtheoretical Model

The Transtheoretical Model, also known as the Stages of Change Model, is a health promotion and maintenance model that describes the stages of behavior change individuals go through when attempting to make positive changes in their health behaviors. The model includes five stages: pre-contemplation, contemplation, preparation, action, and maintenance. 

The Health Belief Model considers the likelihood of change as related to the patient's perceived threat of illness coupled with their belief in the effectiveness of a treatment. While it may be appropriate to consider this model, the patient has not expressed recognition of a threat of illness or a desire to understand the efficacy of treatment as a consideration for change, making the Transtheoretical Model more important to consider. Social Cognitive Theory and the Ecological Model are not as relevant as the Transtheoretical Model.

13.

What key concept in the nurse/client relationship can prompt a provider to feel recurrent anxiety and uneasiness when dealing with a particular client?

  • Countertransference

  • Transference

  • Projection

  • Denial

Correct answer: Countertransference 

Countertransference is a provider's emotional reaction to the client based on their experiences. 

Transference is the displacement of feelings for significant people in the client's life to their PMHNP. While denial or projection may play a peripheral role in some instances of countertransference, neither of these options is correct.

14.

Which of the following is a risk factor for substance abuse?

  • Chronic pain

  • Older

  • Female gender

  • Treatment for chronic pathological anxiety

Correct answer: Chronic pain

Chronic pain is a known risk factor for substance abuse. Young males are more likely to have substance abuse issues than older or female individuals. Untreated chronic pathological anxiety is a known risk factor.

15.

Which term best describes the use of aggregate variance data to change a system of healthcare practice?

  • Outcomes management

  • Information technology

  • Database management system

  • Informatics

Correct answer: Outcomes management 

Outcomes management is the use of aggregate variance data to change a system of healthcare practice. Variance is any event that alters patient progress toward expected outcomes. Sources of variance include practitioner behavior (competency), the severity of illness, and practice patterns that either expedite care or inhibit the delivery of care.

16.

A 24-year-old female presents with complaints of "episodes of utter terror" that seem to begin without cause. During these episodes, she feels extremely anxious with heart palpitations and shortness of breath. These episodes usually last 5 to 10 minutes and have occurred about 15 times over the past six months. She often worries about when she might have another episode. 

What medical condition should be considered in this patient's differential diagnosis?

  • Pheochromocytoma

  • Hypothyroidism

  • Hypertension

  • Folate deficiency

Correct answer: Pheochromocytoma

Pheochromocytoma should be considered in the differential diagnosis of panic disorder. Pheochromocytomas produce symptoms often seen in panic disorder, such as flushing, trembling, and tachycardia. Other medical conditions that mimic panic disorder include the following:

  • Hyperthyroidism
  • Hyperparathyroidism
  • Cardiac arrhythmias

Hypertension, folate deficiency, and hypothyroidism do not usually cause panic-like symptoms.

17.

A 47-year-old female arrives at the emergency room accompanied by the police, who found her "confused and walking strangely." During your examination, you notice pupil abnormalities, depressed deep tendon reflexes, and a positive Romberg sign. She reports a long history of IV drug abuse but does not use alcohol. In the past, she was prescribed an antipsychotic, but she states she has not taken that medication for years. 

Which of the following conditions best accounts for her symptoms?

  • Neurosyphilis

  • Neuroleptic malignant syndrome 

  • Wernicke encephalopathy (Wernicke's syndrome)

  • Korsakoff psychosis (Korsakoff syndrome)

Correct answer: Neurosyphilis

Even though syphilis infections have been declining since World War I, it is important to consider them in a differential diagnosis for a variety of psychiatric presentations. Neurosyphilis is syphilis that involves the central nervous system. Symptoms of neurosyphilis include the following:

  • Wide-based gait
  • Positive Romberg sign
  • Loss of vibratory and proprioceptive senses in lower extremities
  • Decreased deep tendon reflexes
  • Pupil abnormalities
  • Tremors
  • Dyscoordination
  • Spasticity in lower extremities

The patient has not taken antipsychotic medications for years, so her symptoms are likely unrelated to neuroleptic malignant syndrome (NMS). Neuroleptic malignant syndrome is a rare but life-threatening idiosyncratic reaction to neuroleptic medications that is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction. NMS often occurs shortly after the initiation of neuroleptic treatment, or after dose increases.

Wernicke's syndrome, also known as Wernicke encephalopathy, is a neurological disease characterized by the clinical triad of confusion, the inability to coordinate voluntary movement (ataxia), and eye (ocular) abnormalities. Her symptoms cannot be explained by Wernicke encephalopathy.

Korsakoff syndrome is a chronic memory disorder caused by a severe deficiency of thiamine (vitamin B1). Korsakoff syndrome is most commonly caused by alcohol misuse and is often, but not always, preceded by an episode of Wernicke encephalopathy. Her symptoms cannot be explained by Korsakoff psychosis.

18.

Melatonin is a hormone that the brain produces in response to low light levels. Some individuals take OTC melatonin supplements to help with sleep disruption or jet lag. What kind of instructions should the PMHMP provide regarding melatonin and other food and/or medication interactions?

  • Melatonin interacts with aspirin and NSAIDs

  • Melatonin interacts with Tylenol

  • Melatonin cannot be taken with milk

  • Melatonin cannot be taken with other sleep medications

Correct answer: Melatonin interacts with aspirin and NSAIDs

Melatonin interacts with aspirin, NSAIDs, beta-blockers, corticosteroids, valerian, kava kava, and alcohol. There are no known food interactions for melatonin. Melatonin can be given with other sleep medications, as it does not directly suppress the central nervous system.

19.

According to Erik Erikson, during which psychosocial stage would you expect a person to develop a loving sexual relationship?

  • Intimacy vs. Isolation

  • Generativity vs. Stagnation

  • Identity vs. Role Confusion

  • Autonomy vs. Shame and Doubt

Correct answer: Intimacy vs. Isolation

Successful resolution of the psychosocial stage of Intimacy vs. Isolation results in the development of loving sexual relationships. Failure to resolve this stage is characterized by fear of relationships with others. 

Erik Erikson's stages of psychosocial development include the following:

  • Trust vs. Mistrust: birth to 12-18 months
  • Autonomy vs. Shame and Doubt: 12-18 months to 3 years
  • Initiative vs. Guilt: 3 to 5-6 years
  • Industry vs. Inferiority: 5-6 years to adolescence
  • Identity vs. Role Confusion: adolescence to adulthood
  • Intimacy vs. Isolation: adulthood
  • Generativity vs. Stagnation: middle adulthood
  • Ego integrity vs. Despair: late adulthood

20.

A forensic PMHNP should possess theoretical and practical knowledge of the criminal justice and mental health systems, with a good knowledge base of which of the following?

  • Safety, security, management, and risk assessment of individuals

  • Rights of the accused

  • Nonverbal cues of the accused

  • Proper physical assessment of victims

Correct answer: Safety, security, management, and risk assessment of individuals

Each forensic PMHNP should possess theoretical and practical knowledge of the criminal justice and mental health systems. Forensically trained PMHNPs have a good knowledge base of the following:

  • The functions of the court system
  • Litigation procedures
  • Workings of the criminal justice system
  • Relevant case law and health litigation
  • Mental health, distorted thinking patterns, and impaired cognition
  • Safety, security, management, and risk assessment of individuals

The primary knowledge base of forensic PMHNPs does not include understanding the rights of the accused, nonverbal cues of the accused, or proper physical assessment of victims.

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