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Quiz Session - Attempts With Random Questions

AANPCB PMHNP-C Exam Questions

Page 3 of 60

41.

Which of the following is considered a potential conflict of interest?

  • Referral to a family member who is a provider

  • Referral to another provider in the same industry

  • Referral to a random in-network provider

  • Referral to a provider who is a known colleague and in-network but has no financial ties 

Correct answer: Referral to a family member who is a provider

A conflict of interest is a situation in which a person's financial, professional, or personal situation may affect or appear to affect the person's judgment in professional responsibilities. This includes healthcare decisions, research, and other matters, with the potential for personal or professional gain or advantage or disadvantage. 

42.

Which statement accurately describes "with mixed features," a specifier used in the diagnosis of mood disorders?

  • These patients experience a combination of both manic and depressive symptoms

  • These patients have high levels of tension, restlessness, worry, and fear

  • These patients have experienced at least four mood episodes in the past year

  • These patients exhibit either motor hyperactivity or inactivity

Correct answer: These patients experience a combination of both manic and depressive symptoms

Specifiers are special descriptions added to a patient's diagnosis to provide more information. Specifiers help characterize the condition and describe its overall course. Specifiers used to describe mood disorders include the following:  

  • With atypical features: These patients eat a lot, gain weight, sleep excessively, and have a feeling of being sluggish or paralyzed. They are also sensitive to rejection.
  • With melancholic features: These patients feel worse in the morning than in the afternoon, and they experience decreased appetite, weight loss, and agitation. They also tend to feel excessively guilty and have trouble making decisions.
  • With anxious distress: These patients have high levels of tension, restlessness, worry, and fear.
  • With catatonic features: These patients exhibit either motor hyperactivity or inactivity.
  • With mixed features: These patients experience a mixture of both manic and depressive symptoms.
  • With peripartum onset: These patients develop a mood episode during pregnancy or within a month of having their baby.
  • With psychotic features: These patients develop delusions or hallucinations along with their mood symptoms.
  • With rapid cycling: These patients have experienced at least four mood episodes in the past year.
  • With a seasonal pattern: These patients regularly become ill at a certain time of the year.

43.

Which of the following statements is true regarding adolescents and suicide?

  • Suicide is a significant risk in adolescents suffering from depression

  • More adolescent girls attempt and commit suicide than adolescent boys

  • A prior suicide attempt does not increase an adolescent's risk of attempting again

  • The suicide rate in adolescents has remained stable over the past few decades

Correct answer: Suicide is a significant risk in adolescents suffering from depression

Suicide is a significant risk in adolescents with depression. Suicide should always be specifically addressed during psychiatric evaluations.

More adolescent girls than boys attempt suicide; however, adolescent boys are five times more likely to complete suicide. A history of a prior suicide attempt greatly increases a person's risk of attempting again. The suicide rate in adolescents has been increasing over the past few decades.

44.

A client states, "Nothing good ever happens to me. I am a failure and should just accept who I am." What would be the best behavioral technique for this individual? 

  • CBT

  • DBT

  • Existential therapy

  • EMDR

Correct answer: CBT

Cognitive behavior therapy (CBT) is most appropriate, as this patient has an all-or-nothing mindset. Their thinking and reasoning can best be mitigated using CBT techniques.

Dialectical behavior therapy (DBT), existential therapy, and eye movement desensitization and reprocessing (EMDR) are not as effective for treating an all-or-nothing mindset when compared to CBT.

45.

You are treating a 45-year-old patient who has been diagnosed with schizophrenia and treated with thioridazine (Mellaril) for the past 15 years. You decide to switch the patient to a different antipsychotic due to what serious long-term consequence that is specific to high-dose thioridazine?

  • Retinal pigmentation

  • Hyperprolactinemia

  • Priapism

  • Tardive dyskinesia

Correct answer: Retinal pigmentation

Retinal pigmentation can occur in patients prescribed >1,000 mg of thioridazine. Even when thioridazine is stopped, this side effect may persist and lead to blindness.

Hyperprolactinemia, priapism, and tardive dyskinesia can occur as side effects of any antipsychotic medication.

46.

A patient has been diagnosed with seasonal affective disorder (SAD), a type of depression that occurs during specific times of the year. What is the most likely hormonal influence on the development of SAD?

  • Decreased levels of melatonin

  • Elevated levels of cortisol

  • Low levels of testosterone

  • Increased levels of estrogen

Correct answer: Decreased levels of melatonin

Seasonal affective disorder is a type of depression that occurs during specific times of the year, typically in the winter. The exact cause of SAD is unknown, but it is believed to be related to changes in the amount of light exposure and the corresponding changes in circadian rhythm and hormone levels.

Melatonin is a hormone the pineal gland produces in response to darkness and regulates sleep and wakefulness. In individuals with SAD, it is thought that decreased melatonin levels may contribute to symptoms such as sleep disturbances, decreased energy, and low mood.

Elevated levels of cortisol, low levels of testosterone, and increased levels of estrogen are not typically associated with SAD, although these hormones may play a role in other types of depression. Understanding the hormonal influences on SAD is important for PMHNPs and other healthcare providers, as it can inform the development of effective treatment strategies for this condition.

47.

Which classification of psychiatric medications requires routine lab work for metabolic monitoring?

  • Second-generation antipsychotics

  • SSRIs

  • Anxiolytics

  • Tricyclic antidepressants 

Correct answer: Second-generation antipsychotics

Patients being prescribed and treated with second-generation antipsychotics and/or most mood stabilizers should have routine laboratory testing to monitor their baseline and help prevent metabolic syndrome. 

SSRIs, anxiolytics, and tricyclic antidepressants all carry a very low risk or no risk of metabolic syndrome.

48.

The goal of which type of therapy is to change the client's faulty conceptions, irrational beliefs, and negative cognitive distortions?

  • Cognitive therapy

  • Psychoanalytic therapy

  • Behavioral therapy

  • Existential therapy

Correct answer: Cognitive therapy

Cognitive therapy, originating with Aaron Beck, purports that external events do not cause anxiety or maladaptive behaviors but that a person's expectations, perceptions, and interpretations of events cause anxiety. The goal of therapy is to change the client's irrational beliefs. 

Behavioral therapy focuses on changing maladaptive behaviors through exposure, relaxation, and problem-solving. Existential therapy is a philosophical approach based on life reflections. Psychoanalytic therapy addresses maladaptive behaviors by increasing insight and awareness. 

49.

Which of the following medications is least likely to induce depression?

  • Disulfiram

  • Propranolol

  • Progesterone

  • Interferon

Correct answer: Disulfiram

The following common medications can induce depression:

  • Beta-blockers such as propranolol
  • Steroids
  • Interferon
  • Isotretinoin
  • Some retroviral drugs
  • Neoplastic drugs
  • Benzodiazepines
  • Progesterone

The following medications can induce mania:

  • Steroids
  • Disulfiram
  • Isoniazid
  • Antidepressants

50.

A PMHNP is caring for a patient who presents with depressive symptoms. What is the primary reason for the PMHNP to conduct a thorough medical screening as part of the patient's assessment?

  • To identify any potential medical causes or contributing factors to the patient's mental health symptoms

  • To determine the patient's eligibility for ECT

  • To ensure that the patient is not at risk for self-harm or harm to others

  • To assess the patient's level of functioning in daily activities

Correct answer: To identify any potential medical causes or contributing factors to the patient's mental health symptoms

Medical screening is an important aspect of the assessment of psychiatric patients, as medical conditions can often contribute to or exacerbate mental health symptoms. For example, hypothyroidism can cause symptoms of depression, while hyperthyroidism can cause symptoms of anxiety. Other medical conditions such as vitamin deficiencies, infections, and neurological disorders can also have an impact on mental health. Therefore, a thorough medical screening can help the PMHNP identify any underlying medical conditions that may be contributing to the patient's mental health symptoms and inform the development of an appropriate treatment plan.

51.

Which practice should the PMHMP avoid when using email to communicate therapeutic information and observations to other healthcare providers?

  • Passwords and login information should be sent via email only to those who are permitted to use the information

  • The email should be printed and attached to the medical record unless emails are regularly archived

  • Every email should be treated as a public document

  • Emails containing patient identifiers or clinical information should be sent in a secure manner

Correct answer: Passwords and login information should be sent via email only to those who are permitted to use the information

Emails should not contain passwords or information that could be intercepted and compromise patient information.

Any email that contains any patient identifier, clinical observations, or opinions should be sent securely. The document should be treated as if it is a public document. All emails sent regarding patient care should be printed and attached to the medical record.

52.

The purpose of which model or framework is to "make sense" of each experience systematically?

  • Reflective practice

  • Critical thinking

  • Conflict resolution

  • Professional civility

Correct answer: Reflective practice

In reflective practice, the provider links theory to practice. This enhances critical thinking to problem-solve and boosts clinical reasoning and decision-making.

Critical thinking involves using critical thinking but does not necessarily involve linking theory to practice and can involve purely theory. Conflict resolution and professional civility relate to interpersonal relationships and do not involve a systematic approach to experiences.

53.

Which of the following statements regarding bipolar disorder by a PMHNP student requires correction?

  • "Each episode must have a precipitating event."

  • "The condition may have a behavioral component."

  • "Patients may have somatic symptoms."

  • "Patients may have cognitive symptoms."

Correct answer: "Each episode must have a precipitating event."

Patients suffering from bipolar disorder can present as either expansive in mood or depressed, depending on the episode. Each episode may have a precipitating event but often occurs without any identified stressor. Patients manifest behavioral, affective, cognitive, and somatic symptoms.

54.

Black box warnings for carbamazepine include which of the following conditions?

  • Agranulocytosis

  • Thrombocytopenia

  • Hemophilia

  • Polythycemia vera

Correct answer: Agranulocytosis

Black box warnings are indications by the FDA of potential serious side effects and should be considered in the treatment planning of patients. Black box warnings for carbamazepine include both agranulocytosis and aplastic anemia. 

Thrombocytopenia, hemophilia, and polycythemia vera are not commonly associated with the use of carbamazepine.

55.

You are a nurse practitioner treating a 15-year-old male with a diagnosis of oppositional defiant disorder. He has been stable on Adderall for his ADHD for the past year. However, his mother is concerned because his aggression has been getting worse over the past three months, and she does not understand the sudden change in her son's behavior. 

Which of the following actions is the most appropriate for you to take?

  • Ask the mother if the patient is being seen concurrently by his primary care provider for his ADHD

  • Ask the patient if he was sexually abused three months ago

  • Ask the patient if he is angry about something

  • Refer the patient to a psychotherapist for behavior modification

Correct answer: Ask the mother if the patient is being seen concurrently by his primary care provider for his ADHD

In this scenario, we are not addressing the ODD but rather the potential for either abuse of Adderall or overmedication of stimulants. One of the side effects of being overmedicated with Adderall is aggression. Furthermore, stimulants are a Schedule II drug, and this class carries a high risk for potential abuse. Often, primary care providers treat their patients for ADHD and prescribe a stimulant. It is important to assess whether the patient is being prescribed too much medication or if he is secretly taking more than he is prescribed. 

The other options may apply here, but the most important intervention is to ensure the patient has not been prescribed too much Adderall by another provider.

56.

Which of the following best describes migrant workers?

  • They leave their permanent residence to take agricultural jobs in different locations

  • They travel from their permanent residence seasonally for agricultural employment

  • They have a lower risk of depression, anxiety, and substance use

  • They are typically men from all cultures

Correct answer: They leave their permanent residence to take agricultural jobs in different locations

Seasonal workers travel from their permanent residences seasonally for agricultural employment. Migrant and seasonal workers have very high incidences of depression, anxiety, and substance use. 

Migrant and seasonal workers include men, women, and children of all cultures.

57.

Which hormone disruption is most likely to cause early morning awakening in a depressed patient?

  • Elevated cortisol

  • Decreased cortisol

  • Elevated catecholamine

  • Elevated testosterone

Correct answer: Elevated cortisol

Elevated cortisol is often seen in individuals with depression who experience an early morning awakening. Both catecholamines and testosterone are decreased in those with depression.

58.

A patient arrives for a follow-up for depressive symptoms. She has been taking Norpramin for years. Today, she reports not feeling well. She thinks she has had the flu for a couple of days. Prior to falling ill, she reports doing great. In fact, she felt cured of her depression and stopped her medication. 

Which of the following should the PMHNP suspect and rule out as a contributor?

  • Discontinuation syndrome

  • Pregnancy

  • Worsening symptoms of depression

  • Flu

Correct answer: Discontinuation syndrome

When certain medications are discontinued, particularly TCAs, flu-like symptoms can occur due to cholinergic rebound.

Pregnancy, worsening symptoms of depression, and flu are less likely for this patient than discontinuation syndrome.

59.

A person diagnosed with schizotypal personality disorder, schizoid personality disorder, or paranoid personality disorder falls under which category of personality disorders?

  • Cluster A

  • Cluster C

  • Cluster B

  • These patients do not fall within a category of personality disorders

Correct answer: Cluster A

Cluster A disorders are:

  • Paranoid personality disorder
  • Schizoid personality disorder
  • Schizotypal personality disorder

Cluster B disorders are:

  • Antisocial personality disorder
  • Borderline personality disorder
  • Histrionic personality disorder
  • Narcissistic personality disorder

Cluster C disorders are:

  • Avoidant personality disorder
  • Dependent personality disorder
  • Obsessive-compulsive personality disorder

60.

Substance use screening tool interpretation is an important part of an advanced assessment and of the role of the psychiatric-mental health nurse practitioner. What is the most common tool used to assess for alcoholism specifically in geriatric populations?

  • S-MAST

  • CIWA

  • COWS

  • AUDIT

Correct answer: S-MAST

The S-MAST, also known as the Michigan Alcoholism Screening Test for Geriatrics, is a clinical assessment tool used to assess and screen for alcoholism in geriatric populations.

The COWS (Clinical Opiate Withdrawal Scale) assessment is used to assess the withdrawal severity of opiates.

The CIWA assessment is used to assess the withdrawal severity of alcohol and/or benzodiazepines.

The AUDIT assessment is also an alcohol use assessment tool but is not specific to geriatric populations.

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