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Quiz Session - Attempts With Random Questions

AANPCB PMHNP-C Exam Questions

Page 10 of 60

181.

A patient with a diagnosis of Prader-Willi syndrome has been admitted to the children's inpatient psychiatric unit. For this neurodevelopmental disorder, which of the following dietary considerations are an important part of treatment?

  • A restricted-calorie diet

  • A high-fiber diet

  • A gluten-free diet

  • A high-protein diet due to low muscle tone

Correct answer: A restricted-calorie diet

Prader-Willi syndrome is a neurodevelopmental and genetic disease characterized by compulsive eating, intellectual disability, hypogonadism, small stature, low muscle, and low muscle tone. Due to their hypotonic and compulsive eating, these patients are prone to obesity and must maintain a low-calorie diet.

182.

Mr. Smith is a 25-year-old sales associate. He has a strong family history of mental illness and is worried that he may experience similar problems in his life. He presented to his local primary care provider complaining of the following symptoms: extreme hyper-alertness, decreased appetite, insomnia, and paranoia. Mr. Smith is worried that these symptoms might be the beginning of a mental illness and requests an X-ray of his brain. He says he has never seen a psychiatric provider or taken medication for his symptoms. 

What would be an initial consideration in your assessment when meeting with Mr. Smith?

  • Ensuring that Mr. Smith understands appropriate diagnostics and testing for determining a mental illness

  • Educating Mr. Smith on his need for Wellbutrin immediately

  • Performing genetic testing prior to moving forward with the evaluation

  • Assessing Mr. Smith for the need for voluntary inpatient admission

Correct answer: Ensuring that Mr. Smith understands appropriate diagnostics and testing for determining a mental illness

Patients often misunderstand and misinterpret diagnostic testing. Explaining this first is important in moving to the diagnostic phase so that all appropriate options for diagnosing his condition can be explored.

Prescribing Wellbutrin immediately is not an appropriate initial intervention, as Mr. Smith is most likely experiencing an increase in norepinephrine. Wellbutrin is an NDRI.

Although performing genetic testing may be necessary, it is often not approved by insurance after an initial visit and if the patient has not used psychotropics in the past.

Mr. Smith is not a danger to himself or others and is not gravely disabled and thus does not meet the criteria for inpatient admission.

183.

A PMHNP is conducting a mental status exam on a patient with a history of schizophrenia. The patient begins to speak in a rhyming pattern, using words that are associated with similar sounds rather than meaning. What is the term for this phenomenon?

  • Clang associations

  • Echolalia

  • Neologisms

  • Word salad

Correct answer: Clang associations

Clang associations are a symptom commonly seen in patients with schizophrenia in which the patient uses words that are associated with similar sounds rather than meaning. The patient may speak in a rhyming pattern, using words that have no apparent connection to the topic. For example, a patient may say "I'm fine, it's time, I'll dine on a lime" instead of "I feel okay, it's getting late, I'm going to have some dinner." Clang associations may be a sign of disordered thinking and can make communication difficult.

Echolalia is the repetition of words or phrases that have been heard previously. Neologisms are newly invented words or phrases that have no meaning to others. Word salad is a jumbled collection of words and phrases that have no logical or meaningful connection.

184.

Which statement is true regarding bipolar disorder and pregnancy?

  • Clonazepam (Klonopin) does not carry an increased risk of major fetal malformations

  • Lithium (Lithane, Lithobid) is safe during the first and third trimesters

  • Carbamazepine (Tegretol, Carbatrol, Equetro) is a safe alternative to lithium carbonate

  • Divalproex sodium (Depakote) is a safe alternative to lithium carbonate

Correct answer: Clonazepam (Klonopin) does not carry an increased risk of major fetal malformations

Commonly used mood-stabilizing medications for bipolar disorder carry an increased risk of major fetal malformations. However, clonazepam, lorazepam, and alprazolam are effective in the management of acute manic episodes as an adjuvant to maintenance therapy instead of antipsychotics. As an adjuvant to lithium or lamotrigine, clonazepam may result in increased time between cycles and fewer depressive episodes.

During the first trimester, the use of lithium (Lithane, Lithobid) increases the risk of fetal cardiac malformations to 7.7%. Lithium can be used in the second and third trimesters, but it must be stopped peripartum due to the rapid fluid shifts during birth. Both carbamazepine (Tegretol, Carbatrol, Equetro) and divalproex sodium (Depakote) increase the risk of neural tube defects.

185.

A phenotype is the observable characteristic of a specific trait and is connected to the genetic contributions to that trait. Which of the following is an example of a phenotype associated with the fast metabolism of medications?

  • CYP4502D6

  • Adenine

  • Thymine

  • Cytosine

Correct answer: CYP4502D6

A phenotype, not a genotype, is the observable characteristic of a specific trait and is connected to the genetic contributions to that trait. CYP4502D6 is an example of an expressed trait that contributes to the fast metabolism of medications. 

Adenine, thymine, and cytosine are all nucleotide bases that make up a DNA strand.

186.

In 2010, the Institute of Medicine published The Future of Nursing: Leading Change, Advancing Health. Which of the following, if identified by a PMHNP student as being included this document, requires correction?

  • Nurses should remain virtuous, modest, and ethical

  • Nurses should practice to the full extent of their education

  • Nurses should seek higher levels of education through seamless academic progression

  • Nurses should be full and equal partners with physicians

Correct answer: Nurses should remain virtuous, modest, and ethical 

The Future of Nursing: Leading Change, Advancing Health considered the obstacles that all nurses encounter as they provide high-quality health care in the United States. They developed four key messages:

  1. Nurses should practice to the full extent of their education.
  2. Nurses should seek higher levels of education through seamless academic progression.
  3. Nurses should be full and equal partners with physicians.
  4. To improve the quality of health care, nurses need an improved information infrastructure.

187.

What communication technique is best used by PMHNPs when responding to a client who is hesitant about undergoing a new treatment?

  • Reassurance

  • Humor

  • Reflection

  • Therapeutic silence

Correct answer: Reassurance

Reassurance can help reduce anxiety by providing emotional or logical support while the patient makes an important decision.

Humor is used to decrease tension and facilitate open communication. Reflection helps to summarize what has already been discussed. Therapeutic silence is best for allowing the patient time to process emotions or facilitate further expression by the patient.

188.

In forensic nursing, which of the following is the basis of the nurse-client relationship? 

  • Crime committed and investigational aspects of the interaction

  • Psychiatric diagnoses

  • Psychiatric and comorbid diagnoses

  • Severity of the offense and past history of aggression toward others

Correct answer: Crime committed and investigational aspects of the interaction

In forensics, the nurse-client relationship is based on the crime committed and the investigational aspects of the interaction. This basis of the relationship is not focused on diagnosing or providing care for the patient outside of the investigation of the crime.

189.

A PMHNP is working with a patient who is struggling with feelings of isolation and a lack of meaningful relationships of purpose. Which of Erik Erikson's stages of psychosocial development is this patient likely experiencing?

  • Intimacy vs. Isolation

  • Trust vs. Mistrust

  • Industry vs. Inferiority

  • Identity vs. Role Confusion

Correct answer: Intimacy vs. Isolation

Erik Erikson's theory of psychosocial development describes eight stages of life, each presenting a unique challenge or conflict that individuals must resolve to move to the next stage of development. Intimacy vs. Isolation is the sixth stage of development, which occurs during early adulthood (ages 18-40). This stage is characterized by a need for intimacy and connection with others and a desire to find a sense of purpose and direction in life. Failure to resolve this conflict can lead to feelings of loneliness, isolation, and despair.

190.

A patient with bipolar disorder is being assessed using the Young Mania Rating Scale. Which of the following symptoms would a PMHNP least expect to assess when using the scale?

  • Suicidal ideation and self-harm behaviors

  • Increased activity and energy levels

  • Irritability and aggression

  • Rapid speech and flight of ideas

Correct answer: Suicidal ideation and self-harm behaviors

The Young Mania Rating Scale (YMRS) is a tool used to assess the severity of manic symptoms in patients with bipolar disorder. The scale includes 11 items that assess the patient's level of energy, activity, thought and speech patterns, mood, and behavior. Items on the YMRS include increased activity and energy levels, irritability and aggression, rapid speech and flight of ideas, and many others. PMHNPs should be familiar with the YMRS and other assessment tools to assess and manage manic symptoms in patients with bipolar disorder.

However, the scale does not include items related to suicidal ideation and self-harm behaviors, which are better assessed using other tools such as the Columbia-Suicide Severity Rating Scale (C-SSRS).

191.

An elevated temperature in a patient taking mood stabilizers and antipsychotics such as clozapine may be most concerning for which of the following?

  • Agranulocytosis

  • Increased metabolic rate

  • Dehydration

  • Infection

Correct answer: Agranulocytosis

Agranulocytosis is a potentially serious risk when prescribing patients mood stabilizers such as carbamazepine and antipsychotics such as clozapine. The patient should be assessed for this condition if presenting with an elevated temperature. 

Increased metabolic rate, dehydration, and infection can all be related to an elevated temperature, however, agranulocytosis would be the most pertinent and most serious condition to consider.

192.

A nurse is caring for a patient who has been diagnosed with post-traumatic stress disorder (PTSD) and is receiving treatment with eye movement desensitization and reprocessing (EMDR). What is the primary goal of EMDR in the treatment of PTSD?

  • To help the patient desensitize to traumatic memories and reduce the intensity of associated emotions

  • To help the patient integrate the traumatic memory into their personal narrative

  • To help the patient reframe negative thoughts and beliefs related to the traumatic event

  • To help the patient identify triggers and develop coping strategies to manage symptoms

Correct answer: To help the patient desensitize to traumatic memories and reduce the intensity of associated emotions

Eye movement desensitization and reprocessing (EMDR) is a psychotherapeutic approach that is often used in the treatment of PTSD. The primary goal of EMDR is to achieve adaptive resolution. This involves helping the patient desensitize to traumatic memories and reduce the intensity of emotions associated with the trauma.

193.

As a nurse practitioner, you will be responsible for assessing physical signs of child abuse. Which of the following is least indicative of abuse?

  • Inattention and distraction during the well-child exam

  • Bite marks on the neck

  • Painful, untreated dental caries

  • Bruising on padded parts of the body

Correct answer: Inattention and distraction during the well-child exam

Inattention and distraction could be age-appropriate or a sign of ADD/ADHD, but it is not a sign of child abuse. 

Common indicators of child abuse:

  • History of unexplained multiple fractures
  • Burns, hand or bite marks
  • Injuries at various stages of healing
  • Evidence of neglect
  • Bruising on padded parts of the body

194.

The neuron is comprised of three parts: cell body, axon, and dendrite. What is the role of the axon?

  • Transmits signals away from the neuron's cell body to connect with other neurons and cells

  • Conveys information from the central nervous system to skeletal muscles

  • Collects incoming signals from other neurons and sends the signals toward the neuron's cell body

  • Maintains and restores energy by inhibiting the activity of organs

Correct answer: Transmits signals away from the neuron's cell body to connect with other neurons and cells

The neuron is comprised of three parts: cell body, axon, and dendrite. The axon transmits signals away from the neuron's cell body to connect with other neurons and cells. The dendrite collects incoming signals from other neurons and sends the signals toward the neuron's cell body.

195.

A PMHNP is providing care to a patient who has been diagnosed with a terminal illness. The patient has recently entered the bargaining phase of death and dying. Which of the following best describes the goal of the bargaining phase?

  • To help the patient negotiate a compromise with a higher power or fate in an attempt to postpone their death

  • To help the patient accept their terminal diagnosis and prepare for their impending death

  • To help the patient find meaning and purpose in their life and to make sense of their illness and impending death

  • To help the patient express their feelings of sadness, anger, and fear related to their illness and death

Correct answer: To help the patient negotiate a compromise with a higher power or fate in an attempt to postpone their death

The bargaining phase is a stage of the Kubler-Ross model of grief and dying, in which patients may try to negotiate a compromise with a higher power or fate in an attempt to postpone their death. This can involve making promises or deals in exchange for more time or attempting to find a way to avoid or delay the inevitable. 

The goal of the bargaining phase is not to help the patient accept their terminal diagnosis or to find meaning and purpose in their life, although these may be important factors in other stages of the dying process.

196.

What is a use of biofeedback?

  • When a client has stress-related symptoms such as anxiety

  • When a client has depressive symptoms

  • When hypersomnia is a major factor

  • When a client is suffering from neurological problems such as a seizure disorder

Correct answer: When a client has stress-related symptoms such as anxiety

Biofeedback is a process providing a person with visual or auditory information about the autonomic physiological functions of their body, such as blood pressure, muscle tension, and brain wave activity.

Biofeedback is used in the following situations:

  • Stress-related symptoms such as anxiety
  • Pain
  • Insomnia
  • Neuromuscular problems such as migraines or muscular tension
  • Neurobehavioral disorders
  • Enhancement of healing
  • Athletic and work performance

197.

A PMHNP uses motivational interviewing as a therapeutic technique with a patient. Which of the following is accurate regarding motivational interviewing?

  • It assumes that the willingness and motivation for change are intrinsic

  • The PMHNP imposes awareness that the client is unable or unwilling to see

  • The PMHNP provides instruction for knowledge lacking in the patient

  • The PMHNP advises the patient on what needs to be done

Correct answer: It assumes that the willingness and motivation for change are intrinsic

Motivational interviewing builds on the premise that the client or patient is an expert on themselves. When using MI, the PMHNP forms a partnership with the client in a noncoercive manner. 

Traditional counseling is more confrontational and instructive and tells the patient what to do.

198.

When considering the nurse-client relationship and treatment, what should the nurse practitioner should ensure?

  • The focus is on the client and their clinical needs

  • Social interaction is avoided at all times

  • The nurse practitioner should ensure that they are the only provider treating their close friends or family members to maintain continuity of care

  • The client has the right to see who they want, regardless of the social impact on their care and the decisions of their provider

Correct answer: The focus is on the client and their clinical needs 

Social interactions on a professional level are appropriate as long as the nurse practitioner maintains healthy boundaries. 

Treating close friends or family members creates an ethical dilemma and should be avoided at all times. Depending on state licensure and scope of practice, the provider could be compromising certain regulations and statutes by treating family members; this is never advised and is a poor practice habit.

Although the client does have the right to see who they choose, the nurse-client relationship is a two-way relationship. The provider has a responsibility to ensure that the relationship is a good fit and that it meets certain standards of care required by each state.

199.

Which of the following would be least likely to be recommended as a nonpharmacological method of managing ADHD?

  • Diet modifications

  • Behavior therapy

  • Treatment for learning disorders

  • Family therapy and education

Correct answer: Diet modifications

Nonpharmacological management of ADHD includes all of the following:

  • Behavior therapy
  • Treatment for learning disorders
  • Family therapy and education
  • Psychoeducation
  • Patient and parent cognitive behavioral training

200.

What psychiatric condition is characterized by two or more motor tics and at least one vocal tic that occur frequently throughout the day?

  • Tourette's disorder

  • Stuttering

  • Attention-deficit/hyperactivity disorder

  • Oppositional defiant disorder

Correct answer: Tourette's disorder

For a person to be diagnosed with Tourette's disorder, they must:

  • Have two or more motor tics (e.g.,  blinking or shrugging the shoulders) and at least one vocal tic (e.g., humming, clearing the throat, or yelling out a word or phrase), although they might not always happen at the same time.
  • Have had tics for at least a year; the tics can occur many times a day (usually in bouts) nearly every day, or off and on
  • Have tics that begin before 18 years of age
  • Have symptoms that are not due to taking medicine or other drugs or due to having another medical condition (e.g., seizures, Huntington disease, or postviral encephalitis).

Attention-deficit/hyperactivity disorder is characterized by hyperactivity, impulsivity, and inattentiveness. Stuttering, also called childhood-onset fluency disorder, occurs when the normal fluency of speech is frequently interrupted. Oppositional defiant disorder is characterized by multiple examples of negativistic behavior persistent for at least six months, usually beginning when a child is three or four years old.

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