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Quiz Session - Attempts With Random Questions

AANPCB PMHNP-C Exam Questions

Page 4 of 60

61.

What court case determined that the presence of a mental illness alone cannot justify involuntary hospitalization?

  • O'Connor v. Donaldson

  • Durham v. United States

  • Rennie v. Klein

  • Roger v. Oken

Correct answer: O'Connor v. Donaldson

The 1976 case O'Connor v. Donaldson ruled that harmless mentally ill patients cannot be confined against their will if they can survive outside. This case determined that the presence of a mental illness alone cannot justify involuntary hospitalization.

In 1979, Rennie v. Klein determined that patients have the right to refuse any treatment and use an appeal process. In 1981, Roger v. Oken determined that patients have an absolute right to refuse treatment but that a guardian may authorize their treatment. Durham v. United States determined that an individual is not criminally responsible if the unlawful act was the product of mental illness. This case is known for originating the insanity defense.

62.

In a family systems context, what is the definition of morphogenesis?

  • A family's tendency to adapt to change when changes are necessary

  • A family's tendency to remain stable in the midst of change

  • A family's tendency to resist change and maintain a steady state

  • The barriers that protect and enhance the integrity of families

Correct answer: A family's tendency to adapt to change when changes are necessary

Morphogenesis refers to a family's tendency to adapt to changes when necessary.

Morphostasis is a family's tendency to remain stable amid change. Family homeostasis is a family's tendency to resist change and maintain a steady state. Boundaries are the barriers that protect and enhance the functional integrity of families.

63.

Negative symptom clusters of schizophrenia include which of the following?

  • Attention deficits

  • Disorganized behaviors

  • Delusions

  • High anxiety

Correct answer: Attention deficits

Other negative symptom clusters are affective flattening, alogia or poverty of speech, avolition, apathy, abstract thinking problems, and anhedonia.

Positive symptom clusters include hallucinations, delusions, disorganized behaviors, hostility, grandiosity, mania, and paranoia.

Associated symptom clusters include inappropriate affect, dysphoric mood, depersonalization, derealization, and high anxiety.

64.

Which of the five phases of group dynamics is marked by participants frequently exhibiting resistance and sabotaging behaviors?

  • Storming 

  • Forming 

  • Norming

  • Performing

Correct answer: Storming 

The stages of group dynamics are similar to the three phases of individual therapy in that the early phases are characterized by hesitancy and resistance until a therapeutic alliance is established. The second phase of the formation of groups is called "storming," as clique formation and loss of control behaviors may surface. These behaviors include hesitancy and sabotage. 

65.

Sara is a 22-year-old female in the inpatient psychiatric unit for acute paranoia and delusional thought processes. Upon admission, the psychiatric-mental health nurse practitioner orders 10 mg of Haldol and 25 mg of Benadryl to be given by mouth STAT. Two hours later, Sara presents to the nurses' station complaining of severe abdominal cramps and an elevated heart rate. You receive a call from the charge nurse explaining the patient's symptoms. 

You determine that Sara is most likely suffering from acute dystonia and order which medication to be given immediately? 

  • Cogentin 2 mg IM STAT

  • Benadryl 25 mg PO STAT

  • Cogentin 1 mg PO STAT

  • Klonopin 0.5 mg PO STAT

Correct answer: Cogentin 2 mg IM STAT

For acute dystonia, Cogentin 2 mg IM STAT is the best intervention, as Benadryl had previously been given without preventative effects. 

Cogentin 1 mg PO is a good option but not the best for treating an acute presentation.

Klonopin 0.5 mg is appropriate for preventative measures but will not provide immediate relief from the acute presentation.

66.

As a nurse practitioner, you are responsible for assessing cranial nerves as a part of the neurological exam. What cranial nerve assessment tests the strength of the sternocleidomastoid and trapezius muscles against the resistance of the provider's hands?

  • Accessory spinal

  • Trigeminal nerve (sensory division)

  • Trigeminal nerve (motor division)

  • Facial

Correct answer: Accessory spinal 

The accessory spinal (cranial nerve XI) assessment tests the strength of the sternocleidomastoid and trapezius muscles against the resistance of the provider's hands.

The trigeminal nerve (cranial nerve V, sensory division) assessment tests for tactile perception of the facial skin. The trigeminal nerve (cranial nerve V, motor division) assessment tests for masseter muscle strength. The facial nerve (cranial nerve VII, motor division) assessment checks for flaccid paralysis.

67.

Which of the following meets the criteria for involuntary admission to a psychiatric hospital?

  • Inability to care for self

  • Medication noncompliance

  • Permission from the patient's guardian

  • Presence of at least one mental disorder

Correct answer: Inability to care for self 

Involuntary admission to a psychiatric hospital is justified when the patient is:

  • An imminent danger to self
  • An imminent danger to others
  • Unable to care for themselves adequately

The criteria for involuntary admission come from the legal doctrine of police power (state as protector) and parens patriae (state as parent). Parens patriae allows the state to intervene and act as a surrogate parent for those who are unable to care for themselves or who may harm themselves. Police power allows the state to intervene if the patient is a danger to others.

68.

Which term describes the death rate for a given population?

  • Mortality rate

  • Morbidity rate

  • Disease hazard rate

  • Illness hazard rate

Correct answer: Mortality rate

The mortality rate describes the death rate for a given population, as measured by the ratio of the number of deaths to the average size of the population during a given period.

The morbidity rate describes the rate at which a given disease is present in a population. Illness hazard rate and disease hazard rate are not scientific terms.

69.

A patient has suffered a stroke in Broca's area of the brain and is experiencing difficulty communicating. Which of the following interventions would best promote the optimization of the patient's long-term functionality?

  • Refer the patient to a speech therapist

  • Prescribe an antidepressant medication

  • Administer cognitive-enhancing medication

  • Offer a communication board for the patient to use

Correct answer: Refer the patient to a speech therapist

Broca's area, located in the frontal lobe, is responsible for language production and speech. A stroke in this area can result in a condition known as Broca's aphasia, characterized by difficulty with speech production, grammar, and word finding. Speech therapy is the primary intervention for patients with Broca's aphasia, as it can help the patient regain their ability to communicate.

Antidepressant and cognitive-enhancing medication may help with mood and cognitive function but would not address the language production issue. A communication board may be helpful for the patient, but it would not address the underlying problem. A speech therapist would be the best option.

70.

A PMHNP leads a group therapy session for patients with substance use disorders. Which of the following is a potential benefit of using a heterogeneous group in this setting?

  • Opportunity to learn from diverse perspectives

  • Increased group cohesiveness and trust

  • Enhanced feelings of safety and security

  • Greater social support and acceptance

Correct answer: Opportunity to learn from diverse perspectives

In group therapy, a heterogeneous group includes members with diverse backgrounds, experiences, and personalities. Using a heterogeneous group in therapy can provide many benefits, including the opportunity to learn from diverse perspectives. In the context of substance use disorders, a heterogeneous group can provide members with exposure to different life experiences, coping strategies, and recovery techniques they may not have encountered independently. This exposure can help members broaden their understanding of their experiences and develop new insights and coping strategies.

71.

What term describes a health plan that allows individuals to establish tax-free savings funds to finance their medical care?

  • Medical savings account plan

  • Medicare + Choice

  • Medicare Advantage

  • Medigap insurance policy

Correct answer: Medical savings account plan

A Medicare medical savings account plan allows individuals to establish tax-free savings funds to finance their medical care. 

Medicare + Choice was part of the Balanced Budget Act of 1997, which significantly increased the number of managed care insurance plans available to Medicare recipients. This program was replaced with the Medicare Advantage plan in 2003. 

The Medicare Advantage plan created regional Preferred Provider Organizations (PPO) and gave Medicare enrollees the option of enrolling in private insurance plans. 

Medigap insurance policies are private policies purchased by elderly individuals to cover some or all of their medical expenses not paid for by Medicare.

72.

Which of the following is an example of a biological preventative factor that protects someone from developing a psychiatric disorder?

  • Healthy nutritional status

  • Internal locus of control

  • Good self-concept

  • Higher level of education

Correct answer: Healthy nutritional status

Preventative factors are factors that protect a person from developing a psychiatric condition. They fall into three categories: biological, psychological, and social. Healthy nutritional status is an example of a biological preventative factor.

Biological preventative factors:

  • Without a history of mental illness in the family
  • Healthy nutritional status
  • Good general health

Psychological preventative factors:

  • Good self-esteem
  • Good self-concept
  • Internal locus of control
  • Healthy ego defenses

Social preventative factors:

  • Low-stress occupation
  • Higher socioeconomic status
  • Higher level of education

73.

For which reason do anxious patients initially seek treatment?

  • Non-specific cardiac-related symptoms

  • Inability to sleep

  • Worry and anxiety

  • Fear of job loss

Correct answer: Non-specific cardiac-related symptoms

Patients often seek treatment when they experience nonspecific cardiac-related symptoms such as chest pain, numbness, tingling, or shortness of breath. An inability to sleep, worry, and anxiety over losing a job are all symptoms of anxiety but do not cause a patient to seek treatment as frequently as cardiac-related symptoms.

74.

Which moral duty does a nurse practitioner leader uphold by telling the truth?

  • Veracity

  • Respect

  • Fidelity

  • Justice

Correct answer: Veracity

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

75.

You are a nurse practitioner treating a seven-year-old male. His mother states, “My son’s teacher at school is concerned about him because he is not able to finish his in-class schoolwork. I just don’t know what to do.” You suspect the client may have attention-deficit hyperactivity disorder (ADHD), but you need more information. The child reportedly fails to give attention in class, fidgets, gets distracted often, is disorganized with his assignments, constantly loses his homework, distracts other students, and interrupts class activities. 

Which of the following symptoms is indicative of inattention?

  • Constantly loses his homework

  • Fidgets

  • Distracts other students

  • Interrupts class activities

Correct answer: Constantly loses his homework

Hyperactive and impulsive traits of ADHD are as follows:

  • Fidgets
  • Leaves seat
  • Runs or climbs
  • Is unable to engage in quiet activities
  • Is always on the go
  • Talks excessively
  • Blurts out information
  • Has a difficult time waiting their turn
  • Interrupts others

Inattentive traits of ADHD include the following:

  • Fails to give attention to details
  • Has difficulty sustaining attention
  • Does not listen when spoken to
  • Does not follow through on instructions
  • Is disorganized
  • Avoids or dislikes tasks that require sustained mental effort
  • Loses things
  • Is distracted
  • Is forgetful

76.

What term most accurately describes a group of members of Congress or a political party created to support a defined political ideology?

  • Caucus

  • Special interest group

  • Grassroots lobby

  • Legislative assistants

Correct answer: Caucus 

A caucus is a group of members of Congress or a political party created to support a defined political ideology.

Grassroots lobbying occurs when nonpaid individuals contact their legislators to influence policy. A special interest group is a collection of individuals who coordinate lobbying efforts around a common interest and seek to influence policymakers. A legislative assistant is an employee of a senator or representative who keeps the legislator informed, meets with constituents, and drafts reports.

77.

What is as a chronic, fluctuating mood disorder with symptoms similar to—but less severe than those of bipolar disorder?

  • Cyclothymia

  • Intermittent explosive disorder

  • Oppositional defiant disorder

  • Histrionic personality disorder

Correct answer: Cyclothymia

Cyclothymia (cyclothymic disorder) can be described as a chronic, fluctuating mood disorder with symptoms similar to—but less severe than—those of bipolar disorder. These patients have numerous periods of hypomanic and dysthymic symptoms.

78.

A PMHNP is seeing a client for the first time for suspected MDD. The client reports fatigue, low energy, a lack of interest in things normally enjoyed, and increasing irritability. She does not have a history of depression or other psychiatric treatment. She had been prescribed Synthroid for hypothyroidism but reports, "I stopped taking it months ago because I felt fine and it's not cheap." The PMHNP suspects low thyroid hormone as a causative factor in the current symptoms, and initial blood work reveals elevated TSH. The client denies suicidal ideation, has a supportive family, and is still working as a store clerk. 

What is the PHMNP's best course of action once they are confident the cause is medical?

  • Refer the patient to the primary care provider

  • Restart Synthroid at the previous dose and monitor; schedule the patient for a follow-up visit in 2 weeks

  • Restart Synthroid and manage both the thyroid disorder and depression as an outpatient

  • Refer to inpatient hospitalization for stabilization of mood and medications

Correct answer: Refer the patient to the primary care provider

For non-psychiatric disorders, the PMHNP should refer the client to a primary care provider. Although the PMHNP is legally able to provide some primary care, the standard of care is to make a referral.

79.

A 76-year-old male is admitted to the hospital due to community-acquired pneumonia and dehydration. On day three of his hospitalization, he becomes withdrawn, stops eating, and exhibits a fluctuating level of consciousness. He has no previous psychiatric history. During your examination, he is drowsy and oriented to person only. His vital signs are normal. 

What is the most likely diagnosis?

  • Delirium

  • Major depressive disorder

  • Dementia

  • Generalized anxiety disorder

Correct answer: Delirium

This man is exhibiting the usual signs of delirium, including impaired consciousness, difficulty with cognition, and disorientation. Some patients with delirium appear depressed and withdrawn, and others appear agitated and hyperactive. 

The patient's acute onset and fluctuating level of consciousness rule out major depressive disorder, generalized anxiety disorder, and dementia.

80.

Which of the 10 curative factors of group psychotherapy allows participants to learn about intimacy and relationship dynamics?

  • Interpersonal learning

  • Universality

  • Group cohesiveness

  • Increased development of social skills

Correct answer: Interpersonal learning

Interpersonal learning is one of the 10 curative factors of group therapy. Group therapy provides a safe space for personal interactions with others to allow for opportunities to learn about relationship dynamics. 

Interpersonal learning allows participants to learn about vulnerability and intimacy with others in a shared, safe, and mentored space.

Universality is the discovery that others have similar circumstances, feelings, and responses. Group cohesiveness is an increased sense of belonging with the group. Increased development of social skills results when the group provides feedback on an individual's social skills.

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