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Quiz Session - Attempts With Random Questions

AANPCB PMHNP-C Exam Questions

Page 6 of 60

101.

A patient with suspected dementia is brought to the clinic for evaluation. During the mental status exam, the PMHNP notes several findings that are consistent with dementia. Which of the following is a common finding in patients with dementia?

  • Poor judgment

  • Decreased or absent psychomotor activity

  • Disorganized speech

  • Hallucinations

Correct answer: Poor judgment

The mental status exam is a tool used by healthcare providers to assess a patient's cognitive function. In patients with dementia, several findings may be present. Poor judgment is a common finding in dementia, as patients may have difficulty making decisions or engaging in appropriate behaviors. Other common findings in patients with dementia include memory impairment, language impairment, and impaired executive function.

Decreased psychomotor activity is not typically seen in patients with dementia. Patients with dementia may have slowed movements but are not typically inactive. Disorganized speech may be seen in some patients with dementia, but it is not a defining feature. Patients with dementia may struggle to find the right words or express themselves clearly. Hallucinations are not typically seen in dementia, although they may be present in some patients with Lewy body dementia or other types of dementia.

102.

A patient presents with symptoms of depression and has been diagnosed with major depressive disorder (MDD). What is the most likely pathophysiological explanation for the patient's symptoms?

  • Imbalance of neurotransmitters

  • Chronic inflammation

  • Abnormal hypothalamic-pituitary-adrenal (HPA) axis function

  • Increased oxidative stress

Correct answer: Imbalance of neurotransmitters

MDD is a complex condition that is thought to result from a combination of genetic, environmental, and neurobiological factors. The most widely accepted theory of depression is the monoamine hypothesis, which states that an imbalance of neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain causes depression. Imbalances in these neurotransmitters are thought to contribute to symptoms such as sadness, fatigue, sleep disturbances, and decreased motivation.

Chronic inflammation, abnormal HPA axis function, and increased oxidative stress are also thought to contribute to depression. Still, the role of these factors is less well understood and is considered secondary to the imbalance of neurotransmitters. Therefore, the nurse practitioner should prioritize assessing and managing neurotransmitter imbalances in the care of a patient with MDD.

103.

A patient is being evaluated using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). The patient reports spending several hours each day washing her hands, cleaning her house, and checking door locks. She also experiences intrusive thoughts about harming her family. What is the rationale for using the Y-BOCS to evaluate this patient's symptoms?

  • The Y-BOCS is a diagnostic tool used to assess the presence and severity of intrusive thoughts and compulsive behaviors

  • The Y-BOCS is a diagnostic tool used to assess self-aggression and self-injury

  • The Y-BOCS is a diagnostic tool used to evaluate the presence and severity of anxiety symptoms

  • The Y-BOCS is a diagnostic tool used to evaluate the presence and severity of depression symptoms

Correct answer: The Y-BOCS is a diagnostic tool used to assess the presence and severity of intrusive thoughts and compulsive behaviors

The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is a diagnostic tool used to evaluate the presence and severity of obsessive-compulsive disorder (OCD). It measures the severity of both obsessions (intrusive thoughts) and compulsions (repetitive behaviors), and it is considered the gold standard for assessing OCD symptom severity.

104.

The evidence hierarchy ranks sources of knowledge according to the strength of the information they provide. Which study would appear in Level 1 of an evidence hierarchy?

  • Meta-analysis

  • Randomized controlled trial

  • Qualitative study

  • Opinions of expert committees

Correct answer: Meta-analysis

Evidence-based practice demands the use of the best knowledge. The evidence hierarchy ranks sources of knowledge according to the strength of the information they provide. The best evidence comes from Level 1 of the evidence hierarchy, which includes meta-analyses. All levels are listed below. 

  • Level 1 (strongest): Systematic review of randomized controlled trials or systematic review of nonrandomized trials
  • Level 2: Single randomized controlled trial or single nonrandomized trial
  • Level 3: Systematic review of correlational or observational studies
  • Level 4: Single correlational or observational study
  • Level 5: Systematic review of descriptive, qualitative, or physiologic studies
  • Level 6: Single descriptive, qualitative, or physiologic study
  • Level 7 (weakest): Opinions of authorities and expert committees

105.

A PMH-NP is caring for a 52-year-old man with a 30-year PPD smoking habit and a significant history of alcohol use. He has been employed at a landfill for 25 years. The patient presents with symptoms of depression and irritability. "I think I'm going crazy. I can't see right; my brain's messed up, I can't think. I can't walk right. I can't even talk right. I think I sometimes hear people's voices that aren't even there!" A review of medical symptoms reveals an ataxic gait, dysarthria, and peripheral neuropathy. 

Based on the patient's biopsychosocial history, which of the following environmental toxins should be ruled out as a contributing factor first?

  • Mercury

  • Lead

  • Manganese

  • Arsenic

Correct answer: Mercury

Environmental toxins impact physical and mental health. Based on the patient's history of working in a landfill, mercury poisoning should be suspected and ruled out. Mercury poisoning presents with neuropsychiatric symptoms (including psychosis) and medical symptoms (ataxia, peripheral neuropathy, and dysarthria). 

Lead poisoning can lead to severe lead encephalopathy with dizziness, ataxia, headaches, and possible delirium but does not have the associated dysarthria or neuropathies the patient is reporting. Manganese can manifest as "manganese madness" with symptoms of excited laughter, nightmares, and emotional lability. Early signs of arsenic poisoning are skin pigmentation and GI disturbances. 

106.

A PMHNP is providing anticipatory guidance to parents of a two-year-old child. Which of the following is the most important topic to address during this visit?

  • Limiting screen time

  • Potty training

  • Reading to the child

  • Beginning vaccinations

Correct answer: Limiting screen time

Anticipatory guidance is a key component of well-child care, and it involves providing parents with information and education to help them promote their child's healthy development. When working with parents of a two-year-old child, the most important topic to address during this visit is limiting screen time. The American Academy of Pediatrics recommends that children between two and five years old have no more than one hour of screen time per day and that time should be spent on high-quality programming. Excessive screen time can have negative effects on a child's development, including language delays, poor sleep, and behavioral problems.

While the other topics like potty training and reading to the child are important for a child's overall development, limiting screen time is the most critical topic to address during this visit because it can have such a significant impact on a child's development. Vaccinations should begin at birth, not at two years old.

107.

A nurse is providing care to a patient who discloses that they are experiencing intimate partner violence. Which of the following actions is the priority in the nurse's response?

  • Providing the patient with resources for safety and support

  • Documenting the patient's disclosure in the medical record

  • Offering emotional support and validation to the patient

  • Encouraging the patient to report the abuse to law enforcement

Correct answer: Providing the patient with resources for safety and support

Intimate partner violence (IPV) is a serious public health issue that affects individuals of all ages, genders, and sexual orientations. Nurses have a critical role in identifying and responding to IPV, and the priority in their response should be to ensure the patient's safety and provide them with access to resources for support.

108.

Which of the following risk factors is most associated with an increased likelihood of developing depression in an adult patient?

  • Female gender

  • Lower educational history

  • Recent life stressors

  • Incarceration

Correct answer: Female gender

Risk factors for the development of depression include genetic predisposition, a first-degree relative with MDD or dysthymia, or being female. Depression may be associated with life changes like stressors or incarceration, however, these are more peripheral risk factors.

109.

What statement accurately defines excoriation disorder?

  • These patients so persistently pick at their skin that they leave scars

  • These patients accumulate so many objects that it interferes with their ability to function

  • These patients pull hair from various parts of their body

  • These patients are bothered by repeated thoughts or behaviors

Correct answer: These patients so persistently pick at their skin that they leave scars

Excoriation disorder patients so persistently pick at their skin that they leave scars.

Obsessive-compulsive disorder patients are bothered by repeated thoughts or behaviors. Trichotillomania patients pull hair from various parts of their body. Hoarding disorder patients accumulate so many objects that it interferes with their ability to function.

110.

What statement accurately describes schizoaffective disorder?

  • A disorder characterized by patients experiencing symptoms of schizophrenia along with either depression or mania

  • A disorder characterized by symptoms of schizophrenia for only one to six months

  • A disorder characterized by at least one psychotic symptom present for less than one month

  • A disorder characterized by the presence of delusions but no other symptoms of schizophrenia

Correct answer: A disorder characterized by patients experiencing symptoms of schizophrenia along with either depression or mania

Schizoaffective disorder is characterized by patients experiencing symptoms of schizophrenia along with either depression or mania.

Delusional disorder is a psychotic disorder characterized by the presence of delusions but no other symptoms of schizophrenia. Brief psychotic disorder is characterized by at least one psychotic symptom present for less than one month. Schizophreniform disorder is characterized by symptoms of schizophrenia for only one to six months.

111.

Which of the following assessment findings regarding thought content for an anxious patient would be least likely?

  • Indiscriminate enthusiasm

  • Goal-directed

  • Overall organized

  • Redirectable

Correct answer: Indiscriminate enthusiasm

Indiscriminate enthusiasm would typically be found during a mental status exam for mania. Goal-directed, overall organized, and redirectable behaviors are common thought processes that manifest with anxiety.

112.

A PMHNP provides care for a patient who reports experiencing "Latah," a culture-bound syndrome characterized by involuntary obedience, echolalia, and echopraxia after a startling event. How should the PMHNP proceed with the treatment plan?

  • Incorporating an understanding of Latah into the diagnostic assessment and treatment planning.

  • Treat the symptoms as purely psychiatric, focusing on medications for symptom management.

  • Refer the patient to a neurologist, understanding the patient is providing a culture-specific explanation for known neurological symptoms.

  • Explain that these symptoms are of a cultural origin and are not a clinical concern.

Correct answer: Incorporating an understanding of Latah into the diagnostic assessment and treatment planning.

Acknowledging the cultural context of the patient's symptoms allows for a more nuanced and comprehensive approach to care. This approach respects the patient's cultural background and integrates it into the diagnostic and treatment planning process.

While medication may be part of the treatment, focusing solely on psychiatric medications without considering the cultural context may not fully address the patient's condition or the cultural significance of their symptoms. Although neurological assessment may be part of a comprehensive evaluation, referral to a neurologist without considering the cultural context may overlook the significance of the culture-bound syndrome and its impact on the patient's mental health. It should not be assumed that the patient is misattributing neurological symptoms to a culture-bound syndrome. Advising the patient to ignore their symptoms dismisses their concerns and the cultural significance of their experience, potentially undermining the therapeutic relationship and resulting in an important condition going untreated.

113.

A patient with a history of childhood abuse is seeing a PMHNP for therapy. During a session, the patient becomes angry and accuses the PMHNP of being "just like" their abuser. What is the term for this phenomenon?

  • Transference

  • Countertransference

  • Projection

  • Splitting

Correct answer: Transference

Transference is a phenomenon in which a patient's feelings and attitudes toward another are unconsciously transferred onto the therapist. This may include feelings of love, hate, anger, or mistrust. Transference is often seen in patients with a history of trauma or interpersonal difficulties, as they may have unresolved feelings toward significant others in their lives.

Countertransference is when a therapist unconsciously transfers their feelings and attitudes onto the patient. Projection is when the patient unconsciously attributes their feelings or attitudes to someone else. Splitting is a defense mechanism in which the patient views people and situations as all good or all bad and may have difficulty integrating both positive and negative aspects of a person or situation.

114.

Which of the following is least likely to be a barrier to the implementation of meaningful use by a healthcare organization?

  • Lack of incentive

  • Staff training

  • Workflow changes

  • Altered patient-provider interaction

Correct answer: Lack of incentive 

Barriers to the implementation of meaningful use include staff training, usability, workflow changes, altered patient-provider interaction, and clinician resistance to change.

The federal government did provide incentives in the form of financial rewards and potential reductions in Medicare reimbursement.

115.

Melatonin is known to interact with which substance?

  • Aspirin

  • Tylenol

  • Warfarin

  • Turmeric

Correct answer: Aspirin

Melatonin is known to interact with aspirin, NSAIDs, beta-blockers, corticosteroids, valerian, kava kava, and alcohol.

116.

A PMHNP screens a patient for traumatic brain injury (TBI) using the Glasgow Coma Scale. Which of the following is not assessed by this scale?

  • Cognitive function

  • Eye-opening response

  • Verbal response

  • Motor response

Correct answer: Cognitive function

The Glasgow Coma Scale (GCS) is a tool used to assess the level of consciousness in patients with traumatic brain injury. The scale results in a score by assessing three areas: eye-opening response, verbal response, and motor response. Each area is scored on a scale from 1 to 5, with a maximum score of 15. Cognitive function is not assessed to obtain a GCS. PMHNPs should be familiar with the GCS and other tools for screening and assessing TBI to ensure timely and appropriate treatment.

Other tools, such as the Standardized Assessment of Concussion (SAC) or the Brief Traumatic Brain Injury Screen (BTBIS), may be used to assess cognitive function in patients with suspected TBI.

117.

Which of the following disorders should the PMHNP assess for when there is suspected disruption of the nigrostriatal dopaminergic pathway?

  • Parkinson's disease

  • ADHD

  • Hyperprolactinemia

  • Low motivation

Correct answer: Parkinson's disease

 Parkinson's disease results from a disruption of the nigrostriatal dopaminergic pathway. 

When the transmission of dopamine is disrupted in the mesocorticolimbic pathway, disorders such as ADHD, addiction, and schizophrenia can result. 

A disruption in the tuberoinfundibular pathway results in hyperprolactinemia. Disruptions in the caudate nucleus dopaminergic pathway can create low motivation.

118.

A 26-month-old female is being evaluated for impairments in social interactions, development, communication, and behavior. A review of the patient's history reveals normal prenatal and perinatal development. Her parents describe normal psychomotor development until about 5 months of age. At that time, the parents noticed their daughter appeared to lose previously obtained hand motor skills and became clumsy. Her speech and language development were impaired, along with social engagement. 

Based on the presenting symptoms, the PMHNP suspects which of the following diagnoses?

  • Rett syndrome

  • Autism spectrum disorder

  • Childhood disintegrative disorder

  • Intellectual disability

Correct answer: Rett syndrome

Rett syndrome occurs primarily in girls; normal growth and development are followed by a progressive and deteriorating course starting at around 5 months of age. Children are described as clumsy with a decline in hand motor skills as a signature symptom. 

Although intellectual disability is associated with Rett syndrome, it is not associated with the described course of deterioration in acquired skills. Autism's predominant symptoms are social, communication, and behavioral. The presence of declining motor skills aligns best with the diagnosis of Rett syndrome. Childhood disintegrative disorder's onset is usually around 3-5 years.

119.

Good self-esteem, a healthy self-concept, and an internal locus of control are all examples of which kind of preventative factor?

  • Psychological prevention

  • Primary prevention

  • Secondary prevention

  • Tertiary prevention

Correct answer: Psychological prevention

These are all examples of psychological preventative factors. Primary, secondary, and tertiary prevention are public health principles.

120.

What is an example of a factor facilitating the growth of the nurse practitioner role?

  • Patient acceptance of the nurse practitioner role

  • Reimbursement struggles with Medicare

  • Mandatory physician supervision

  • Resistance from powerful medical organizations

Correct answer: Patient acceptance of the nurse practitioner role

Factors facilitating the growth of the nurse practitioner role include:

  • Patient demand for services
  • Patient acceptance of and satisfaction with nurse practitioners
  • Decreasing stigmatization of psychiatric illnesses
  • Emphasis on the need for integrated healthcare services

Factors constraining the growth of the nurse practitioner role include:

  • Growing competition in the job market
  • Reduction in salary due to nurse practitioner oversupply
  • Reimbursement struggles with Medicare and private insurance companies
  • Legislative battles for independent practice
  • Mandatory physician supervision
  • Resistance from powerful medical organizations
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