PMHNP Test Bank Part 2

7A 45-year-old man was brought to the ED by the police after being called by neighbors due to loud shouting. The patient and his had engaged in a physical altercation, both are treated for minor injuries. The PMHNP is called to do a psychiatric evaluation. On review of the ED records, you find that the patient has a 20-year history of bipolar disorder, last hospitalization was 5 years ago he reports adherence to his treatment regimen that consists of lithium and risperidone. When you enter the exam room, you ob that he is red-faced, sitting cross-legged, and is refusing to answer any questions. Your best response is:
Chan, 19, is a college sophomore who is being seen by the PMHNP in follow-up after discharge from a hospitalization one week for a psychotic episode. Chan’s parents live in Taiwan and he lives in an apartment with his brother who is a PhD student. Chan polite, well-groomed and quiet. He answers questions about his sleep and medication with one word responses and is unable to provide detail when questioned further. He sits on the edge of the couch, his eye contact is minimal and he looks frequently to t and then to the door. The PMHNP’s next best option is to:
Edna, a 72-year-old woman, is brought in to the ED by her neighbor who reports finding her outside in her nightgown talking to in particular. The neighbor reports that he has known Edna for years and has never seen any unusual behavior in the past. Edna by herself but has a daughter living nearby that occasionally checks on her. An appropriate initial step in Edna’s evaluation wou Order CBC with differential and urinalysis.
A 27-year-old ex-Marine is being evaluated during a follow-up visit for post-traumatic stress disorder. He has been taking an SSRI for the past 3 weeks but does not report any improvement in his symptoms. During the evaluation, he mentions that he has thoughts of suicide and specifically mentions a firearm in his house. An appropriate next course of action would be to:
Refer for inpatient care.
8A 68-year-old man of Asian ancestry with generalized anxiety disorder presents for follow-up. He tells you that he is taking diffe herbs to help “clean his blood.” An appropriate response will be:
“Can you tell me more about these herbs?”
Mrs. Sanchez is a 38-year-old Spanish-speaking woman who comes in to the clinic to follow -up for her treatment of depression. accompanied by Tomas, her 10-year-old nephew. Tomas states, “I am here to help my aunt since she does not speak English.” W of the following is the most appropriate approach to this clinical encounter?
Contact a professional telephone-based language translation service.
When compared to White psychiatric patients, Black psychiatric patients are more likely to:
Be involuntarily hospitalized for care.
A 56-year-old Muslim woman presents for an office visit. Her records show that she has been in the U.S. for less than a year and has not had an examination in over 10 years. She mentions that she does not want to disrobe or remove her head cover. You co that:
The option of having a modified physical examination with minimal disrobing should be discussed with the patient.
The PMHNP is aware that the LGBTQ population is a marginalized group so she modifies office forms and her history-taking appr accordingly. Which of the following is not an appropriate question while taking a patient history as it demonstrates a lack cultur awareness by the PMHNP?
Do you have a girlfriend?
9Mr. Jackson is a 72-year-old man who is recently diagnosed with prostate cancer. Prior to his next appointment, he speaks with t prostate cancer survivors, joins an online chat -group for patients with prostate cancer, and spends at least 2 hours a day on the reading about prostate cancer. His actions are an example of:
The above-mentioned mechanism Mr. Jackson is using would be an example of which of the following? Neurotic
Which of the following is a defense mechanism that is helpful to the patient and likely to move the patient forward in meeting h coping needs?
A 56-year-old woman, Mrs. Davis, drinks at least a 12-pack of beer every evening. She refuses to believe that her drinking is problematic though her relatives report several examples of situations where her drinking has resulted in harm. For example, one evening she started a small house fire after starting dinner and then passing out, and on another occasion she drove her truck into the ditch. Had it not been for neighbors and family she might have died. She is exhibiting an example of which defense mechanism?
Based on the scenario:
A 56-year-old woman, Mrs. Davis, drinks at least a 12-pack of beer every evening. She refuses to believe that her drinking is problematic though her relatives report several examples of situations where her drinking has resulted in harm. For example, one evening she started a small house fire after starting dinner and then passing out, and on another occasion she drove her truck into the ditch. Had it not been for neighbors and family she might have died. Which of the following best describes the type of defense mechanism exhibited by Mrs. Davis?
In the above-mentioned example of Mrs. Davis, a rationalization statement would be:
Rationalization is an example of which of the following?
A 32-year-old man being treated for depression describes his attempt to socialize at a recent party as a “complete nightmare” a “nothing went right.” This is an example of which cognitive distortion?
Labeling of distortions is a technique often used in:
Cognitive behavioral therapy
Mr. Jacobs is a 65-year-old man with COPD and a 60 pack-year history who is currently smoking 1.5 packs of cigarettes per day. is reading a pamphlet in your office about smoking cessation. You ask him if he has any questions and he states, “I don’t plan to smoking. My health is pretty good.” According to the Transtheoretical Model of Change, he is most likely in which of the followin stages?
You see a 55-year-old woman with major depressive disorder, type 2 diabetes mellitus, hypertension, and dyslipidemia. Evaluati today reveals a BMI=36 kg/m2. She states, “I just do not know where to start in trying to lose some weight.” Which of the follow the most appropriate response to this statement?
“What barriers do you see to losing weight?”
Which of the following is not a technique used in motivational interviewing?
The communication skill that involves repeating what was being said in a different way and with different words is:
Examining the pros and cons of change is conducted during which stage of change?
Which of the following is not a goal of the maintenance stage of change?
When the NP experiences feelings or thoughts towards a client, this is termed:
While conducting a therapeutic session with a 24-year-old male with major depressive disorder, all of the following techniques a utilized during cognitive behavioral therapy except:
Mary is a 36-year-old accountant who is undergoing psychotherapy for postpartum depression. Which of the following technique consistent with an Interpersonal Psychotherapy (IPT) approach?
John, a 26-year-old barista at the local coffeehouse, is being seen routinely to address generalized anxiety disorder. He is also ta a SSRI. At this session, he reports that he went on a date last weekend, but states “It went horribly wrong from the start. Absolu nothing went right that night.” The PMHNP recognizes that these are catastrophizing statements. An appropriate response woul “Can you tell me one thing that went correct that night?”
0Which of the following statements is false regarding the diagnosis of major depression?
Karen, a 48-year- old married woman with 2 teenage children who works as an administrative assistant at the local community college, presents for concerns about irritability. You administer a PHQ-9 and she scores a 17. With this score, you assess that sh has:
Which of the following is not a DSM criterion for major depressive episode?
Altered mood associated with bereavement
Ben, a 22-year-old who works as a short order cook, is being evaluated for persistent depressive disorder (dysthymic disorder). Which of the following characteristics is most attributed to this mood disorder?
Jeremy, a 36-year-old married attorney, was referred from his primary care provider for a consultation of his depression. He rela problems with what he would call “minor” depression and “mood swings” for at least 15 years. He denies ever having any suici ideation, hospitalization or legal difficulty. On the MDQ he checks 4 items positive and 3 as “possibly positive.” Which disorder m likely fits his symptoms?
The patient with bipolar disorder who is most likely to be misdiagnosed as having a unipolar depression most likely has:
Of the following in need of an antidepressant, who is the best candidate for fluoxetine (Prozac®) therapy?
A 28-year-old woman who occasionally “skips a dose” of her prescribed medication and is using a progestin implant (Nexplanon®, Implanon®) for contraception
You see a 45-year-old woman with major depressive disorder (MDD) who started taking standard-dose sertraline one week ago. She returns today with a chief complaint of “not really feeling any better. In fact, I think I might feel worse. I have this on-and-off headache right over my eyes since I started the medication.” Results of physical examination reveal the following: Well-groomed and appropriately-dressed for the occasion, PERLA, fundi WNL, CN 2–12 intact, clear, fluid speech.
A 26-year-old married woman with a 2-year-old daughter presents for evaluation of depression that she believes began after the of her daughter. She has a BDI score of 23. She relates that she is overall healthy and that she is 16 -weeks pregnant. Which of t following would not be an appropriate course of action?
Advise no medication or therapy at this time
A drug demonstrated to cause teratogenic effects in human study but benefits usually outweigh risk of use in a life-threatening pregnancy risk category:
DThe majority of prescription medications are assigned pregnancy risk category:
CThere is positive evidence that the use of lithium by a breastfeeding woman can pose a risk to the infant. This medication meet
Lactation Risk Category:
L4An overdose of which of the following medications is most likely to be fatal?
Amitriptyline
SSRI withdrawal syndrome is best characterized as:
Bothersome but not life threatening
A 56-year-old woman is seen in the emergency department with headache, dizziness, and marked hypertension (BP=205/145 m She is taking “some medication” for a psychiatric condition but cannot remember the name. She reports that she felt fine the p night as she celebrated her wedding anniversary with a “wonderful dinner” out at a local German restaurant. She is most likely which of the following medications?
A 28-year-old man who works at an accounting firm is being treated with paroxetine 20 mg for major depressive disorder. After weeks, there is little improvement and he continues to feel depressed, having a difficult time focusing at work, and low interest usual enjoyable activities. Prior to therapy his Zung score was 68. Currently his Zung score is 65 and his symptoms are not rem different after 6 weeks of paroxetine therapy. Which of the following would not be recommended for this patient?
Problems with treatment adherence in the patient with bipolar disorder can be addressed in part by acknowledging the ambivalence the patient has towards treatment.
Patients with bipolar disorder are more likely to attempt suicide during manic episodes.
Patients rarely volunteer information about manic or hypomanic symptoms.
Patients usually exhibit limited insight during a manic phase.
A 22-year-old male with type I diabetes mellitus and generalized anxiety disorder is currently being successfully treated for major depressive disorder, recurrent. He has been symptom-free for the past 6 months and he asks if he can stop taking his sertraline. You counsel that he has a high risk of recurrence due to which of the following (more than one option can apply):
Past episodes of depression.
Presence of chronic medical condition.
Co-occurring anxiety disorder.
Which of the following is false when considering discontinuation of treatment for stable major depressive disorder? Treatment should be discontinued immediately rather than tapering doses.
11During a panic attack, symptoms tend to peak at approximately ____ minutes into the episode.
10Which of the following symptoms is not consistent with a panic attack?
The comorbidity of panic disorders with other psychiatric disorders is 90%.
The lifetime prevalence of major depressive disorder in patients with panic disorder is 50%.
A 68-year-old man presents with symptoms of anxiety. He provides a list of medications he is currently taking. Which of the follo is least likely to contribute to his anxiety symptoms?
The abnormal regulation of all of the following is implicated in panic disorder except:
Which of the following is not an essential diagnostic component of GAD?
Medical conditions associated with anxiety-like symptoms include all of the following except:
A 28-year-old female presents for help in managing a generalized anxiety disorder. An appropriate first-line agent is:
In which of the following anxiety disorders is the proportion of the population with the disorder equal between men and women?
Jared, a 24-year-old dental student, establishes care for treatment of OCD. Predictors of poorer prognosis include all of the follow except:
Evan, a 26-year-old factory worker, describes intense anxiety and excessive worry. This occurs any time he has to speak to his b He has a difficult time approaching his coworkers because he feels very self- conscious. He believes he is missing out on possibly important work information because he cannot join into the group of coworkers. He relates racing heart rate, shallow breathing chest tightness. Evan’s symptoms are most consistent with:

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