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Quiz Session - Attempts With Random Questions

AANPCB PMHNP-C Exam Questions

Page 9 of 60

161.

Delirium is known to be associated with high mortality and morbidity. Delirium is presenting more and more in the emergency room setting and is often mistaken for a psychotic emergency or event. As a nurse practitioner, you will be responsible for assessing individuals for psychosis versus delirium. 

Which of the following mnemonics is correct for assessing for delirium?

    • D = Drugs
    • E = Electrolyte abnormality
    • L = Low oxygen saturation
    • I =  Infection
    • R = Reduced sensory input
    • I =  Intracranial
    • U = Urinary or renal retention
    • M = Myocardial
    • D = Dementia
    • E = Electrolyte abnormality
    • L = Low oxygen saturation
    • I =  Infection
    • R = Reduced sensory input
    • I =  Intracranial
    • U = Urinary or renal retention
    • M = Myocardial
    • D = Drugs
    • E = Electrolyte abnormality
    • L = Low oxygen saturation
    • I =  Infection
    • R = Reduced sensory input
    • I =  Intracranial
    • U = Urinary or renal retention
    • M = Medications
    • D = Drugs
    • E = Electrolyte abnormality
    • L = Low oxygen saturation
    • I =  Infection
    • R = Reduced sensory input
    • I =  Intracranial
    • U = Urinary or renal retention
    • M = Mood

Correct answer:

  • D = Drugs
  • E = Electrolyte abnormality
  • L = Low oxygen saturation
  • I =  Infection
  • R = Reduced sensory input
  • I =  Intracranial
  • U = Urinary or renal retention
  • M = Myocardial

The other options are not correct mnemonics for assessing delirium.

162.

Which of the following indicates both an atypical and typical presentation of major depressive disorder?

  • Anhedonia

  • Mood reactivity

  • Leaden paralysis

  • Long-standing pattern of interpersonal rejection sensitivity

Correct answer: Anhedonia

Anhedonia is the inability to feel pleasure, and it occurs in both typical and atypical presentations of major depressive disorder.

An atypical presentation is characterized by the following:

  • Mood reactivity
  • Weight gain
  • Increased appetite
  • Hypersomnia
  • Leaden paralysis
  • Long-standing pattern of interpersonal rejection sensitivity

163.

Which of the following actions takes place during the introduction phase of a therapeutic patient relationship?

  • Establishing professional boundaries

  • Measuring outcomes of care

  • Reprioritizing plan and objectives as indicated

  • Focusing on self-management strategies

Correct answer: Establishing professional boundaries

There are three phases of a therapeutic relationship between a nurse practitioner and a patient:

  1. Introduction
  2. Working
  3. Termination

During the introduction phase, the following actions usually take place:

  • Creating a trusting environment
  • Establishing professional boundaries
  • Establishing the length of anticipated interaction
  • Providing diagnostic evaluation
  • Setting mutually agreed-upon treatment objectives

164.

By graduation, all nurse practitioners are expected to have met a set of core competencies. Which of the following would be incorrect to identify as a core competency in the maintenance of the nurse practitioner-patient relationship?

  • Diagnosing medical conditions and prescribing medication

  • Maintaining professional boundaries

  • Engaging in therapeutic communication

  • Displaying an environment of trust and respect

Correct answer: Diagnosing medical conditions and prescribing medication 

Diagnosing medical conditions and prescribing medication is an example of a core competency in the management of a patient's health status.

Nurse practitioner core competencies are:

  • 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

Core competencies in the maintenance of a nurse practitioner-patient relationship are:

  • Displaying an environment of trust and respect
  • Maintaining professional boundaries
  • Engaging in therapeutic communication

165.

In 2001, the Institute of Medicine published Crossing the Quality Chasm: A New Health System for the 21st Century. This report identified six goals for quality improvement in health care: safe, effective, patient-centered, timely, efficient, and equitable. 

Which goal can be described as avoiding injuries to patients from the care intended to help them?

  • Safe

  • Effective

  • Equitable

  • Patient-centered

Correct answer: Safe

The Crossing the Quality Chasm: A New Health System for the 21st Century report identified six goals for quality improvement in health care:

  • Safe: Avoiding injuries to patients from the care intended to help them
  • Effective: Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit
  • Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values; ensuring that patient values guide all clinical decisions
  • Timely: Reducing waits and sometimes harmful delays for both those who receive and those who provide care
  • Efficient: Avoiding the waste of equipment, supplies, ideas, and energy
  • Equitable: Providing care that does not vary in quality because of personal characteristics, such as gender, ethnicity, geographic location, and socioeconomic status

166.

Which of the following functions should the PMHNP expect to be under the influence of something besides the frontal lobe?

  • Simulating the activity of organs

  • Expressive speech

  • Executive functioning

  • Impulse control

Correct answer: Simulating the activity of organs

The frontal lobe is the largest, most developed lobe. Its functions include the following:

  • Controlling the voluntary motor activity of specific muscles
  • Coordinating movement of multiple muscles
  • Allowing for multimodal sensory input to trigger memories
  • Executive functioning, which includes reasoning, impulse control, planning, prioritizing, intelligence, and abstraction
  • Expressive speech
  • Personality development

167.

Which of the following statements is accurate regarding the diagnosis of dementia of the Alzheimer's type (DAT?)

  • It is the most prevalent type of dementia

  • It has a gradual onset and progressive decline beginning in the fifth decade of life

  • A definitive diagnosis can only be made through brain imaging and serial EEGs

  • It manifests as a progressive cognitive decline in a step-wise fashion

Correct answer: It is the most prevalent type of dementia

DAT is the most prevalent type of dementia that occurs in the sixth decade of life. A definitive diagnosis can only be done via autopsy. 

Vascular dementia is manifested by a progressive cognitive decline in a step-wise fashion.

168.

A PMHNP is working with an elderly patient diagnosed with early-stage Alzheimer's disease. The patient is accompanied by an adult child actively involved in their care. When discussing a new medication regimen, what is the most appropriate approach to ensure informed consent?

  • Provide information to the patient and the adult child, assess the patient's understanding, and attempt to obtain consent from both.

  • Assume the patient is incapable of understanding and obtain consent from the adult child.

  • Obtain consent from the patient at the beginning of the patient interaction.

  • Given the patient’s potential incapacitation, understand that consent is implied and provide treatment accordingly.

Correct answer: Provide information to the patient and the adult child, assess the patient's understanding, and attempt to obtain consent from both.

Ideally, if the patient’s ability to provide consent is unclear, consent should be obtained from both the patient and their legal decision maker if possible. The PMHNP should respect patients' autonomy by involving them in the decision-making process to the fullest extent possible while also considering the practical role of the family in supporting the patient's care. 

Assuming incapacity without assessment disrespects the patient's autonomy and may not be legally sound. Obtaining consent before assessing the patient can disregard cognitive limitations and result in the patient not fully understanding the treatment, compromising informed consent. Assuming that consent is implied is only a valid approach to informed consent if the patient is incapacitated, there is no other way to obtain consent, and delaying treatment to obtain consent is unsafe.

169.

Which of the following would be the best initial single-treatment approach for a client with a generalized anxiety disorder (GAD)?

  • Nonpharmacological management therapy

  • SSRIs

  • Buspirone

  • Benzodiazepines

Correct answer: Nonpharmacological management therapy

Individuals with GAD are good candidates for therapy as a single treatment modality. Therapies such as CBT, relaxation techniques, stress management, and supportive counseling are all options to be attempted before or used in conjunction with pharmacological management.

170.

Which of the following is a systemic effect of hyperthyroidism?

  • Compulsive movement

  • Weight gain

  • Decreased libido

  • Constipation

Correct answer: Compulsive movement

Compulsive movement is a symptom of hyperthyroidism, while the other options are symptoms of hypothyroidism.

Systemic effects of hypothyroidism are:

  • Confusion
  • Decreased libido
  • Impotence
  • Decreased appetite
  • Memory loss
  • Lethargy
  • Constipation
  • Headaches
  • Clumsy movements
  • Syncope
  • Weight gain
  • Fluid retention
  • Muscle aching
  • Slowed reflexes

Systemic effects of hyperthyroidism are:

  • Motor restlessness
  • Emotional lability
  • Short attention span
  • Compulsive movement
  • Fatigue
  • Tremor
  • Insomnia
  • Impotence
  • Weight loss
  • Increased appetite
  • Abdominal pain
  • Excessive sweating
  • Flushing
  • Tachycardia
  • Dysrhythmias

171.

A PMHNP is evaluating a two-year-old pediatric patient for symptoms consistent with childhood-onset schizophrenia. Which of the following would the PMHNP consider when evaluating differential diagnoses?

  • Age

  • Hyperactivity symptoms

  • Night terrors

  • Imaginary friends

Correct answer: Age

Childhood-onset schizophrenia is rare in children under five years of age, so the PMHNP should consider this. Hallucinations or delusions characterize childhood-onset schizophrenia.

Hyperactivity and imaginary friends can be normal for a child of four years.

Night terrors typically occur in children between the ages of three and eight, with the peak age of onset being around four to six years old. Night terrors, also known as sleep terrors, are a type of parasomnia (a sleep disorder) that involves episodes of fear and panic during sleep; they are not diagnostic criteria for schizophrenia.

172.

Which of the following terms may refer to a provider other than an advanced practice nurse?

  • Mid-level provider

  • Nurse practitioner

  • Certified nurse-midwife

  • Nurse anesthetist

Correct answer: Mid-level provider

Some states use the umbrella term advanced practice nurse to refer to nurse practitioners, clinical nurse specialists, nurse-midwives, and nurse anesthetists. Nurse practitioners differ from advanced practice nurses in that they offer a wider range of services to a wider portion of the population.

The term mid-level provider is too broad of a term and is not specific to the scope and practice of the nurse practitioner. "Mid-level" is not an appropriate description of all a nurse practitioner can do and leaves the public with a misunderstanding of the complete services they provide.

173.

What is the most commonly used therapy modality for clients suffering from post-traumatic stress disorder?

  • Eye movement desensitization and reprocessing (EMDR)

  • Cognitive behavioral therapy (CBT)

  • Dialectical behavior therapy (DBT)

  • Interpersonal therapy

Correct answer: Eye movement desensitization and reprocessing (EMDR)

EMDR, proposed by Francine Shapiro, is a form of exposure therapy meant to help the patient address past trauma and work through it for long-term stabilization.

CBT, DBT, and interpersonal therapy are all less likely to be used as a therapy modality for those suffering from posttraumatic stress disorder.

174.

Substance use screening tool interpretation is an important part of advanced assessment and of the role of the psychiatric-mental health nurse practitioner. The most common tool used to assess for alcohol abuse is:

  • CAGE

  • AUDIT

  • CIWA

  • COWS

Correct answer: CAGE

The CAGE screening tool asks the following questions:

  • C = Have you ever felt the need to cut down on your drinking?
  • A = Have people annoyed you by mentioning your drinking?
  • G = Have you ever felt bad or guilty about your drinking?
  • E = Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?

The AUDIT assessment is also an alcohol use assessment tool but is not the most commonly used.

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

The COWS assessment is used to assess the withdrawal severity of opiates.

175.

Which of the following is a disadvantage to prescribing benzodiazepines with short half-lives?

  • Increased risk of addiction

  • Rapid onset of action

  • Less drug accumulation

  • Less daytime sedation

Correct answer: Increased risk of addiction

A disadvantage of benzodiazepines with short half-lives is an increased risk of addiction. Rapid onset of action, less drug accumulation, and less daytime sedation are all advantages of benzodiazepines with short half-lives.

176.

It is important to know the full health history of clients when they come in for treatment, especially prescription and over-the-counter medication history. Which of the following is an example of why it is important to obtain a complete medication history, including over-the-counter medications?

  • Some herbals and dietary supplements are contraindicated during pregnancy and, because they are secreted in breast milk, during lactation

  • All herbals and dietary supplements are contraindicated during treatment of diabetes due to the way they interact with insulin production

  • Herbals and dietary supplements come with black box warnings that need to be adhered to, given the way they interact with prescription medications

  • All herbals and dietary supplements are contraindicated during treatment with psychotropics due to their ability to cross the blood-brain barrier

Correct answer: Some herbals and dietary supplements are contraindicated during pregnancy and, because they are secreted in breast milk, during lactation

Although some herbals are contraindicated during the initial phases of medication management, not all are.

Some, but not all, herbals and dietary supplements are contraindicated during the treatment of diabetes due to the way they interact with insulin production.

Herbals and dietary supplements do not come with black box warnings, as they are not regulated by the FDA.

Only some, not all, herbals and dietary supplements are contraindicated during treatment with psychotropics due to their ability to cross the blood-brain barrier.

177.

Signs and symptoms of Stevens-Johnson syndrome (SJS) include which of the following?

  • Painful mucous membranes

  • Abnormal muscle movements

  • Blurry vision

  • Muscle cramps

Correct answer: Painful mucous membranes

Stevens-Johnson syndrome is a rare potentially life-threatening immune reaction to a foreign antigen that can occur with exposure to any anticonvulsant drug. Treatment includes stopping the offending agent with supportive measures, often in a hospital burn unit. Signs and symptoms of SJS include facial swelling, tongue swelling, macules, papules, burning confluent erythematic rash, skin sloughing, prodromal headaches, malaise, arthralgia, and painful mucous membranes that may occur before the rash appears.

Abnormal muscle movements, blurry vision, and muscle cramps are not cardinal signs of SJS.

178.

Which of the following is incorrect regarding nurse practitioner standards of practice?

  • There are broad variations from state to state due to outdated legislation

  • They offer a way to judge the nature of care provided

  • They reflect expectations of care quality that apply to all psychiatric nurse practitioners regardless of their practice location

  • They reflect the minimum levels of acceptable performance

Correct answer: There are broad variations from state to state due to outdated legislation

Nurse practitioner scope of practice:

  • Defines the nurse practitioner’s roles and actions
  • Identifies competencies assumed to be held by all nurse practitioners who function in a particular role
  • Has broad variations from state to state due to outdated legislation

Nurse practitioner standards of practice:

  • Give authoritative statements regarding the quality and type of practice that should be provided
  • Offer a way to judge the nature of care provided
  • Reflect the expectation for the care that should be provided to patients
  • Reflect professional agreement focused on the minimum levels of acceptable performance
  • Can be used to legally describe the standard of care
  • May be either precise or general guidelines
  • Reflect on guidelines applicable to all psychiatric nurse practitioners regardless of their practice location

179.

How does biofeedback produce its therapeutic effects?

  • It teaches a patient to control their physiological responses

  • It stimulates the olfactory system to elicit feelings and memories

  • It increases blood circulation, improves lymph flow, and enhances musculoskeletal tone

  • It aids in the activity of endorphins by manipulating points of energy flow in the body

Correct answer: It teaches a patient to control their physiological responses

Biofeedback teaches a patient to control their physiological responses. 

Acupuncture and acupressure aid in the activity of endorphins by manipulating points of energy flow in the body. Aromatherapy stimulates the olfactory system to elicit feelings and memories. Massage increases blood circulation, improves lymph flow, and enhances musculoskeletal tone.

180.

Which of the following is an example of meeting the core competency of the management of a patient's health status for a nurse practitioner?

  • Conducting a physical exam and ordering diagnostic tests

  • Offering health promotion and disease prevention techniques

  • Using motivational interviewing to direct behavioral change

  • Providing psychoeducation

Correct answer: Conducting a physical exam and ordering diagnostic tests

Conducting a physical exam and ordering diagnostic tests is an example of managing a patient's health status. 

Nurse practitioner core competencies are:

  • 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 teaching and coaching are:

  • Offering health promotion and disease prevention techniques
  • Using motivational interviewing to direct behavioral change
  • Providing psychoeducation
  • Risk reduction
  • Providing psychopharmacological education
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