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Quiz Session - Attempts With Random Questions

AANPCB PMHNP-C Exam Questions

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21.

What was the original name of the Centers for Medicaid and Medicare Services (CMS)?

  • Health Care Financing Administration

  • National Institute of Health

  • Department of Health and Human Services

  • Food and Drug Administration

Correct answer: Health Care Financing Administration

The Health Care Financing Administration (HCFA) was an agency of the United States Department of Health and Human Services that was created to oversee the financing and quality-control programs for Medicare and the federal portion of Medicaid. The agency has since been renamed Centers for Medicaid and Medicare Services (CMS).

22.

A PMHNP is working with a patient who is diagnosed with a social skills deficit. The PMHNP decides to use social skills rehabilitation as part of the treatment plan. Which of the following is a method used in social skills rehabilitation?

  • Role-playing

  • Relaxation training

  • Cognitive restructuring

  • Mindfulness meditation

Correct answer: Role-playing

Social skills rehabilitation is a type of therapy that focuses on helping patients improve their social skills, such as communication, problem-solving, and assertiveness. Role-playing is a common method used in social skills rehabilitation, where the patient engages in simulated social situations and practices their social skills in a supportive and controlled environment. Role-playing can help patients improve their social skills by providing them with opportunities to practice new behaviors and receive feedback from the therapist and other group members.

23.

At what age does the American Academy of Pediatrics (AAP) recommend screening for autism?

  • Between 18 and 24 months

  • Beginning at 12 months and then at each well-child examination until puberty

  • Between 24 and 36 months

  • Beginning at 6 months

Correct answer: Between 18 and 24 months

Autism rates continue to increase in the United States, with higher rates continuing to be noted among males. While males are diagnosed with autism at a higher rate than females, females with autism are more likely to be misdiagnosed or underdiagnosed due to differences in the presentation of autism. The AAP currently recommends beginning routine screening for autism between 18 and 24 months at well-child examination visits. If a child presents with developmental "red flags" prior to 18 to 24 months raising suspicion of an autism diagnosis, the child should be further evaluated at that time. 

Children with autism spectrum disorders may present with two main types of symptoms: restrictive/repetitive behaviors or social communication/interaction behaviors. 

24.

Some states use the umbrella term advanced practice nurse to refer to multiple types of clinicians. Which type of advanced practice nurse conducts well-woman gynecological care and manages pregnancy, childbirth, antepartum care, and postpartum care?

  • Certified nurse-midwife

  • Clinical nurse specialist

  • Nurse practitioner

  • Nurse anesthetist

Correct answer: Certified nurse-midwife

Some states use the umbrella term advanced practice nurse to refer to nurse practitioners, clinical nurse specialists, nurse midwives, and nurse anesthetists. Each type of advanced practice nurse provides the following services:

  • Nurse practitioner: Evaluate, diagnose, and treat a wide range of medical conditions
  • Clinical nurse specialist: Consult, research, educate, and coordinate care
  • Nurse anesthetist: Preoperative assessment, administration of anesthesia, and postanesthesia recovery
  • Certified nurse-midwife: Well-woman gynecological care, management of pregnancy and childbirth, antepartum and postpartum care

25.

Which of the following is least likely to be a trait of oppositional defiant disorder (ODD)?

  • Blames self for outbursts after calming down

  • Loses temper easily

  • Is spiteful and vindictive

  • Argues with authority

Correct answer: Blames self for outbursts after calming down

Oppositional defiant disorder is an enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior lasting at least six months with at least four of the following associated symptoms:

  • Loses temper
  • Touchy or easily annoyed
  • Angry or resentful
  • Argues with authority
  • Actively defies or refuses to comply with requests or rules from authority figures
  • Blames others
  • Deliberately annoys others
  • Spiteful or vindictive

26.

When treating individuals with personality disorders, a PMHNP understands that nonpharmacological management is the most common form of treatment. The focus of treatment is usually based on issues of limiting setting, coping skills, interpersonal skills, and protection from self-harm. When developing a care plan for an individual with a personality disorder, which of the following would be least likely to be recommended for an individual with a personality disorder?

  • An unstructured environment to promote feelings of control

  • CBT

  • Case management

  • DBT

Correct answer: An unstructured environment to promote feelings of control

Nonpharmacological management of personality disorders often includes multiple therapeutic interventions. These may include case management, different forms of therapy such as CBT or DBT, assisting with realistic expectations, and structuring the environment. 

When a person is feeling out of control or in chaos, an unstructured environment would likely lead to increased feelings of loss of control.

27.

Which of the following is least likely to be used in the pharmacological management of social anxiety disorder?

  • Anticonvulsants

  • Selective serotonin reuptake inhibitors

  • Short-term benzodiazepines

  • Beta-blockers

Correct answer: Anticonvulsants

Anticonvulsants are indicated in the treatment of mood disorders such as bipolar and depression. Although anticonvulsants may be helpful in stabilizing mood disorders, which can lead to a decrease in anxiety, alone they are not indicated for social anxiety disorder.

The other pharmacological management options are all indicated in the treatment of social anxiety (phobia) disorder.

28.

Which of the following does not describe well-designed PMHNP interventions?

  • Standardized for all clients

  • Client-centered

  • Based on evidence-based practice guidelines

  • Client goal-directed

Correct answer: Standardized for all clients

Interventions follow evidence-based practice guidelines, are client-centered and goal-directed, and take into account the client's ethnicity and culture. They are individualized to the client's specific needs and goals.

29.

Which theoretical approach to ethical decision-making views an action as good or bad based on the outcome?

  • Teleological theory

  • Virtue ethics

  • Deontological theory

  • Nonmaleficence

Correct answer: Teleological theory

In teleological theory, an action is determined to be good or bad based on the consequences. 

Deontological theory judges the action as good or bad without factoring in whether the outcome is desirable. Virtue ethics considers the morality of the character deciding determining whether that decision was good or bad. Nonmaleficence is an ethical principle in nursing but not a theoretical approach.

30.

Which legislative act incentivizes pharmaceutical companies to develop drugs to treat rare diseases?

  • Orphan Drug Act

  • Nyman Model Act

  • New Chemical Entities Act

  • Physician Payment Review Commission Act

Correct answer: Orphan Drug Act

The Orphan Drug Act incentivizes pharmaceutical companies to develop drugs to treat rare diseases. These drugs are otherwise unprofitable to develop because the demand is low.

The other options are not acts of Congress. New chemical entities refer to any new substance submitted to the FDA for approval. The Nyman model is an economic theory positing that private health insurance acts as an income transfer between the sick and the healthy. The Physician Payment Review Commission is an independent legislative advisory committee advising the U.S. Congress on methods to pay physicians for services to Medicare beneficiaries.

31.

By graduation, all nurse practitioners are expected to have met a set of core competencies. Which of the following falls outside the core competencies of the management of a patient's health status?

  • Negotiating legislative change

  • Diagnosing medical conditions and prescribing medications

  • Conducting a health assessment and taking a patient's health history

  • Completing a physical exam and ordering appropriate diagnostic tests

Correct answer: Negotiating legislative change

Negotiating legislative change is an example of a professional role core competency. 

Nurse practitioner core competencies include the following:

  • Management of the patient's health status
  • Maintenance of the nurse practitioner-patient relationship
  • Teaching and coaching
  • Professional role
  • Negotiating healthcare delivery systems
  • Monitoring quality of care
  • Providing culturally sensitive care

Nurse practitioner core competencies in the management of a patient's health status are: 

  • Health assessment
  • Health history
  • Physical exam
  • Screening and diagnostic testing
  • Diagnosing
  • Prescribing medications
  • Prescribing other treatment modalities
  • Evaluating care outcomes

32.

A PMHNP is conducting a therapy session with a patient who has a history of negative self-attributions. The PMHNP has decided to use attribution theory as part of the therapy. Which of the following best describes the goal of attribution theory in the treatment of negative self-attributions?

  • To help the patient identify and change their attributional style to more positive and adaptive patterns

  • To help the patient identify and challenge negative behaviors that contribute to their negative self-attributions

  • To help the patient recognize that their negative self-attributions are inaccurate and unfounded

  • To help the patient learn coping skills to manage their negative self-attributions

Correct answer: To help the patient identify and change their attributional style to more positive and adaptive patterns

Attribution theory explains how people make judgments about the causes of their and other people's behaviors. In therapy, attribution theory can help patients identify and change their attributional style, which refers to the patient's tendency to attribute the causes of events or situations to certain factors. Negative self-attributions are often associated with an attributional style that is internal, stable, and global. 

The goal of therapy using attribution theory is to help the patient recognize and change their attributional style to more positive and adaptive patterns.

33.

What does the FDA recommend for pharmacological management of anorexia nervosa?

  • No specific medication therapy 

  • Effexor (venlafaxine)

  • Prozac (fluoxetine)

  • Strattera (atomoxetine)

Correct answer: There is no specific medication therapy for anorexia nervosa

The first-line treatment for anorexia nervosa is psychotherapy. Medication management is to be adjunct to psychotherapy. There is no recommendation by the FDA specifically with regard to medications to treat anorexia nervosa.

SSRIs and TCAs have been shown to be effective in reducing the frequency of binge eating and purging disorders, not anorexia nervosa.

34.

What virtue is associated with the successful resolution of the psychosocial stage of Trust vs. Mistrust?

  • Hope

  • Will

  • Purpose

  • Competence

Correct answer: Hope

According to Erik Erikson, the virtue of hope is associated with the successful resolution of the psychosocial stage of Trust vs. Mistrust. Erikson's stages of psychosocial development are matched with their associated virtue below.

  • Trust vs. Mistrust: Hope
  • Autonomy vs. Shame and Doubt: Will
  • Initiative vs. Guilt: Purpose
  • Industry vs. Inferiority: Competence
  • Identity vs. Role Confusion: Fidelity
  • Intimacy vs. Isolation: Love
  • Generativity vs. Stagnation: Care
  • Ego Integrity vs. Despair: Wisdom

35.

What is a person's culture?

  • The learned beliefs and behaviors that are common among all members of the person's social group

  • A group of adults and children who are usually related and participate in and carry out the essential functions of life

  • The self-identified race, tribe, or nation to which a person or group belongs

  • A group of families often sharing the same race or tribe

Correct answer: The learned beliefs and behaviors that are common among all members of the person's social group

Culture is the learned beliefs and behaviors or the socially inherited characteristics that are common among all members of a group.

A family is a group of adults and children who are usually related and participate in and carry out the essential functions of life. Ethnicity is the self-identified race, tribe, or nation with which a person or group identifies. A community is a group of families often sharing the same race, tribe, or culture and who have beliefs or behaviors not shared by others.

36.

A patient with borderline personality disorder is receiving mentalization-based treatment (MBT). Which of the following best describes the goals of MBT?

  • To improve the patient's ability to understand their and others' mental states and intentions

  • To provide the patient with insight into their unconscious thoughts and feelings

  • To help the patient learn and practice mindfulness techniques to manage their emotions

  • To challenge and change the patient's maladaptive patterns of behavior

Correct answer: To improve the patient's ability to understand their and others' mental states and intentions

Mentalization-based treatment is a psychotherapeutic approach designed to help patients improve their ability to understand their and others' mental states and intentions, especially in the context of interpersonal relationships. This is particularly important for patients with borderline personality disorder, who often struggle with emotional dysregulation and have difficulty understanding their emotions and the emotions of others. PMHNPs should be familiar with MBT to help patients improve their interpersonal relationships, emotional regulations, and overall functioning.

Psychoanalytic psychotherapy aims to provide insight into unconscious thoughts and feelings. Mindfulness-based cognitive therapy involves learning and practicing mindfulness techniques to manage emotions. Cognitive-behavioral therapy aims to challenge and change maladaptive patterns of behavior.

37.

A patient with substance-use disorder is participating in group therapy, and the PMHNP is concerned about imitative behaviors that may arise within the group. Which of the following best describes the role of the PMHNP in preventing imitative behaviors in group therapy?

  • Monitoring patient interactions and intervening if imitative behaviors arise

  • Ensuring patients always model positive behaviors and coping strategies for each other

  • Restricting patient interactions to minimize the risk of imitative behaviors

  • Identifying and removing patients who display imitative behaviors

Correct answer: Monitoring patient interactions and intervening if imitative behaviors arise

Group therapy can be a powerful tool for patients with mental health and substance-use disorders but can also pose a risk for imitative behaviors. Patients may model negative behaviors or coping strategies for each other, leading to a worsening of symptoms or even relapse. It is the PMHNP's responsibility to monitor patient interactions and intervene if imitative behaviors arise. 

The PMHNP cannot control patients' behaviors, however, they can monitor behaviors and intervene if necessary. Removing patients who display imitative behaviors is one form of intervention and is not preferred if other alternatives are available. 

38.

A PMHNP is using a mental health screening tool for secondary prevention for an adult patient who reports feeling sad and experiencing a loss of interest in previously enjoyed activities. Which of the following screening tools is commonly used for this purpose?

  • Patient Health Questionnaire-9 (PHQ-9)

  • Geriatric Depression Scale (GDS)

  • Hamilton Rating Scale for Depression (HAM-D)

  • Beck Anxiety Inventory (BAI)

Correct answer: Patient Health Questionnaire-9 (PHQ-9)

Mental health screening tools are commonly used in primary care settings for secondary prevention, which involves early identification and treatment of mental health disorders. The PHQ-9 is a commonly used screening tool for depression and has been validated in primary care settings. It consists of nine questions that assess the frequency and severity of depression symptoms over the past two weeks. It is reliable, valid, and easy to use in primary care settings.

The Geriatric Depression Scale is a screening tool specifically designed for use in older adults and may not be appropriate for use in all adult populations. The Hamilton Rating Scale for Depression is a more comprehensive assessment tool used to evaluate the severity of depression symptoms and may not be as suitable for use in primary care settings as a screening tool. The Beck Anxiety Inventory is a screening tool used to assess anxiety symptoms and is not specific to depression.

39.

A Psychiatric Mental Health Nurse Practitioner (PMHNP) is considering prescribing psychotropic medication for a patient with depression. Which genetic variations are most likely to influence the patient's response to the drug and lead to a potential gene-drug interaction?

  • CYP2D6

  • APOE4

  • MTHFR

  • SLC6A4

Correct answer: CYP2D6

CYP2D6 is a member of the cytochrome P450 family of enzymes and metabolizes many psychotropic medications, including antidepressants, antipsychotics, and benzodiazepines. Variations in the CYP2D6 gene can lead to reduced or increased activity of this enzyme, affecting the patient's ability to metabolize the medication and potentially leading to a gene-drug interaction. The PMHNP should assess the patient's CYP2D6 genotype and adjust the medication or dose accordingly to avoid potential adverse effects or suboptimal treatment response.

APOE4, MTHFR, and SLC6A4 are also important genetic factors to consider when prescribing psychotropic medications, but CYP2D6 is the most relevant in terms of gene-drug interactions.

40.

Magnetic resonance imaging (MRI) provides a series of three-dimensional images that represent the brain. MRI would be most likely to be contraindicated in which of the following patient scenarios?

  • Patients with a cochlear implant

  • Patients with COPD

  • Patients with known allergies to IV dye

  • Patients on anticoagulant therapy

Correct answer: Patients with a cochlear implant

Cochlear implants/ear implants can be scanned on a 1.5-tesla scanner only after the patient removes the battery. Cochlear implant wrapping scheduling must take place before the patient's scheduled MRI.

The diagnosis of COPD does not exclude the use of this type of imaging, and IV dye may or may not be used in this procedure. There is no contraindication with anticoagulant therapy.

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