PMHNP Test Bank Part 4
Bill is a 67-year-old retired plumber who is accompanied by his wife. She expresses concern about Bill’s mental ability as he see difficulty with word-finding and following conversations. The PMHNP performs a mini mental status exam and he scores an 18. T Moderate Mental Impairment
When assessing a 73-year-old woman with sudden-onset mental status change, all of the following initial diagnostic tests would HIV Test
When considering therapy for a 71-year-old man with mild-to-moderate depression, the PMHNP considers all of the following ex ECT should be avoided in those over 65 years
Indicate whether each of the following characteristics is consistent with delirium, dementia, or both.
Sudden onset of mental status change
Irreversible mental status change
Precipitated by an acute underlying condition
Duration can last months to years
Correct answers:
Sudden onset of mental status change-
Irreversible mental status change-
Precipitated by an acute underlying condition-
Duration can last months to years-
17You see a healthy child who was born at 39 -weeks’ gestation. She can pull to standing position with ease, is not walking solo, en recently began to respond appropriately to the request, “Pick up the spoon.” This baby is approximately ____ months old.
Stranger anxiety typically starts with children at:
9 months old
A 15-year-old adolescent female presents with finger-shaped ecchymotic areas on her right shoulder but denies abuse or assaul “I notice the bruises on your arm are in the shape of a hand.”
Kitana is a 14-year-old girl seen at your clinic for evaluation because her mother found out that she had been using a razor blad the following is false regarding parental consent?
You do not require parental consent prior to treating a psychiatric condition.
Kitana, the patient in the above question, meets the criteria for major depressive disorder. Which of the following is true regardi children?
Based on the scenario below:
Kitana is a 14-year-old girl seen at your clinic for evaluation because her mother found out that she had been using a razor blad Fluoxetine is one of only two medications FDA-approved for use with adolescents.
Cara, a 12-year-old 7th-grader, is diagnosed with juvenile myoclonic epilepsy (JME) and her seizures are well-controlled on topir diagnosis, Cara had been diagnosed with ADHD. She had been treated with methylphenidate, however this was discontinued af diagnosed. Now Cara is failing in school and the Vanderbilt form from the teacher demonstrates significant inattention and distr request that she be put on a medication for ADHD. Which of the following is the best option for Cara?
Start methylphenidate and follow-up in 1–2 weeks
When considering management of ADHD in a 15-year-old, the use of a stimulant medication should be avoided or used with cau of the following? (Choose all that apply.)
Correct answers:
-Hypertension
-Cardiac abnormality
-Prior history of substance abuse
-Presence of motor tics
-History of anxiety or agitated states
An 8-year-old recently diagnosed with ADHD is prescribed a methylphenidate stimulant (Ritalin SR®) as initial treatment. At the the mother reports some improvement in ADHD symptoms but she has noticed the development of a tic consisting of eye blinki recommends:
Switching to atomoxetine (Strattera®).
Peter is a healthy 7-year-old second-grader who lives with his 4-year-old sister and his parents. He is brought to the clinic by his about an 8-month history of behavioral issues. He has an explosive temper, argues with his parents, and blames others for his m that he often does not follow directions and when corrected he becomes defensive and argumentative. The teacher witnessed h into a classmate’s back. When he was confronted about this he denied doing it. You consider the most appropriate course of act Initiate family behavioral therapy
Which of the following is an expected characteristic of a person with severe intellectual disability?
Can perform work-related tasks with supervision
The most common inherited form of intellectual disability is:
True or false? The following are risk factors for conduct disorder.
Male gender
Chaotic parenting environment
Chronic exposure to violence
Past diagnosis of oppositional defiant disorder
Low socio-economic status
Parents have the right to know what their teenager reports to the NP during the psychotherapy appointment. False
True or false?
The patient with anorexia nervosa seldom does not feel hungry.
Patients with bulimia nervosa usually maintain a normal body weight.
Bulimia nervosa is more prevalent than anorexia.
Mood disorders occur in 20% of people with anorexia nervosa and bulimia nervosa.
People with bulimia nervosa are more secretive about their illness than people with anorexia.
When evaluating a 4-year-old boy during an initial visit for signs of separation anxiety disorder, appropriate techniques include the following except:
Ensure child is interviewed separately from parents.
Clinical features supporting in the diagnosis of conduct disorder in a 14-year-old boy include all of the following except:
During an evaluation of a 16-year-old female with substance-use disorder, she confides that she is increasingly confused about her sexual orientation. An appropriate action by the PMHNP is to:
When initiating methylphenidate therapy for a 9-year-old boy with ADHD, the PMHNP educates the family on the possibility of a the following potential adverse effects except:
Which of the following is not a diagnostic criterion for Tourette’s syndrome?
Disorder is associated with substance abuse or medical condition
Tourette’s syndrome is more frequent in males than females.
One-third of children with Tourette’s syndrome will be symptom-free in adulthood.
The most common comorbid disorder in patients with Tourette’s syndrome is obsessive compulsive disorder.
SSRIs are the first-line treatment for separation anxiety disorder.
Functional capacity can help distinguish separation anxiety disorder from normal developmental fears.
The mother of a 5-year-old boy expresses concern about her son who will be starting school soon. She states that “he has alway been very anxious to go anywhere without me or my husband. He would sometimes have major crying fits that often cause him choke and vomit.” The NP replies:
18Age-related changes in older adults can result in a decreased drug effect for all of the following except:
For a patient who is >60 years old, with hepatic impairment, or taking concomitant cimetidine, the recommended daily dose of citalopram should not exceed:
Which of the following psychotropic medications would be preferred in the elderly due to its low anticholinergic and sedation eff Sertraline
Accordi The A1C goal for older adults who are frail or with limited anticipated life expectancy of ≤5 years is:
Age-related changes in the elder include all of the following except:
Potential adverse effects from medications with significant anticholinergic effect include all of the following except:
Absorption of which of the following is least affected by long-term PPI use?
Calcium citrate
PPIs such as lansoprazole, omeprazole and esomeprazole are all inhibitors of CYP450:
TMP-SMX should be avoided in elders who are being concomitantly treated with:
19A 78 Year-old woman with a 30-year history of hypertension and dyslipidemia and a 10-year history of type 2 diabetes presents suspected acute coronary syndrome. She is most likely to report a recent onset of:
Jack is a 16 year-old varsity basketball player who presents for a sports clearance physical examination. His health history is unremarkable and reports excellent activity tolerance. Which of the following would be a finding on Jack’s cardiac examination t would warrant immediate evaluation?
Jane is a 27 year-old woman who presents for a “pap test.” She is new to your practice, has not significant health history and re excellent exercise tolerance, running up to 5 miles 5- 7 days a week and recently was first place in her age division in a 6K road Jane reports taking a low-dose combined oral contraceptive and a daily multivitamin. Physical examination reveals a BMI=22.1 mild pectus excavatum, PMI WNL with both heart sounds intact. There is a midsystolic click with late systolic murmur and the m moves forward with position change from supine to stand. The rest of her physical examination is unremarkable. The next most appropriate step in her care is to:
Mrs. Rivera is an 82 year- old woman with infrequent contact with her HCP. She presents for sick visit with the following chief com “I get really dizzy when I walk up a flight of stairs.” She denies chest pain, agrees that she feels “a bit winded” when physically this symptom resolves quickly with cessation of trigger activity. Physical examination reveals the following: BP=110/90, gr 2/6 h systolic murmur with radiation to the neck, loudest along USB, softer towards axilla,both heart sounds preserved, no S3 or S4, no neck vein distention, no carotid bruit, delayed carotid upstroke. Her clinical presen is most consistent with the presence of:
Raymond is an 18 year- old high school basketball player. He is in for a sports clearance physical examination and denies activit intolerance, chest pain, and syncope. Today’s Assessment Reveals the Following: 74” (188 cm), 220 lb (99.8 kg), Tanner Stage 5 Both heart sounds intact, a grade 2/6 harsh systolic murmur with radiation to the neck, loudest along USB, softer towards axilla somewhat softer with position change from supine to standing, no delay in carotid upstroke, other pulses intact. Raymond’s find are most likely the result of:
Richard is a 62 year- old man w/ HTN heart disease and HF. He presents today for follow up and is without new symptoms. Physi examination reveals the following: PMI @ 5th ICS AAL with a sustained impulse, Gr 3/6 blowing holosystolic murmur with radiati axilla. The murmur accentuated by rolling patient onto left side, softens when going from supine to standing position, louder wit grip, 2d heart sound not preserved, and full carotid upstroke bilaterally is noted. These findings are most consistent with:
20The NP certification exam will contain a number of questions about my state’s NP practice act.
Since each state has distinct requirements for NP scope of practice, no questions specific to a certain state’s practice act will ap exams.
The charge of the State Board of Nursing is to ensure public safety.
State level authorization dictates the ability of the NP to obtain a Federal DEA number.
Which of the following describes the ethical principle of beneficence?
Which of the following describes the ethical principle of utilitarianism?
Which of the following describes the ethical principle of veracity?
An organization has donated 1000 pediatric vaccines to a community clinic. Ensuring that the distribution of the vaccines is don manner is an example of:
A mother presents her 3-year-old son with a 2-day history of cough and runny nose without fever. The NP explains that this is lik treatment should focus on symptom management. However, the mother is insistent on getting a prescription for antibiotics des antibiotics will have limited effectiveness and may cause adverse effects. In this scenario, which of the following best demonstr nonmaleficence?
While walking in the parking lot of a grocery store, an NP notices an elderly man fall and hit his head on the ground. The NP quic the man. This is an example of:
A patient who underwent CABG following a MI develops a surgical site infection. Upon reviewing the patient’s records, the NP no antimicrobial prophylaxis was not provided prior to surgery. The ethical principle of ________ requires the NP to report this finding
A mentally competent patient with advanced cancer is explained 2 treatment options. He decides to take the less invasive tech that his choice has a lower chance for success. Respecting the patient’s choice demonstrates the ethical principle of: Autonomy
A 90-year-old woman with moderate dementia, heart failure, and chronic renal insufficiency presents with a new onset of weakn marked hyperkalemia with a eGFR=22 mL/min/1.73 m2. Nephrology recommends hemodialysis. When discussing this option wi this treatment. She also inaccurately reports the current year, location, and name of the USA president. When asked why she do states, “I do not want to be on a machine. I am quite old and my health is not good.” When asked what she believes will happen she states, “I guess I will die. That is OK.” In reflecting on this patient, the NP appreciates that:
Mr. Nelson is a 75-year-old man in need of surgery. Mr. Nelson has been treated unsuccessfully with conservative therapy for a b Documented on his record is his consent to surgery that was obtained by the chief surgical resident. During your preoperative v and relatively comfortable. His wife mentions that her husband had a dose of promethazine (Phenergan®) to manage his nause consent was obtained. Mrs. Nelson asks, “Is the consent OK since my husband clearly does not feel well?” You respond:
Which of the following best demonstrates the intent of informed consent?
The adult daughter of an 88-year-old man telephones the nurse practitioner to inquire about her father’s medications. The daug relies upon me to explain everything to him.” The nurse practitioner’s initial response is to:
A 50-year-old man of Croatian ancestry has a follow-up appointment after cardiac bypass surgery. The patient brings his father room. They are both fluent English speakers. The NP provides culturally sensitive care by the following action.
You see a 62-year- old man, Mr. Tran, who is from Southeast Asia. He is accompanied in the exam room by his 39-year-old son. B speakers. Mr. Tran is seen in follow-up on type 2 diabetes and hypertension. As you speak with Mr. Tran, he smiles, nods his hea questions. He frequently looks down at the floor. You consider that:
Mr. Miller is a 60-year-old man with hypertension. On today’s office visit, his blood pressure is noted to be 122/78. The rest of hi examination are unremarkable. He mentions that, in addition to his antihypertensive medication you have prescribed, he uses a in a glass of warm water daily to help “clean my blood and lower the pressure. I feel much better when I take it.” Your most app
Mr. Santorini is a 71-year-old man with a 10-year history of hypertension. He is currently taking a fixed-dose lisinopril/hydrochlor reports excellent adherence. On today’s visit, he is without complaint and physical examination is within normal limits, with BP= the past three months, he has been sprinkling a “pinch” of cumin and coriander mixture on his food once a day to “help control reports “feeling like I have more energy” since starting this. You consider that:
He is advocating for his health and the practice should be supported.
A 52-year-old woman who is Muslim arrives for an office visit. Her last primary healthcare visit was more than 10 years ago. She want to disrobe or remove her head cover for a physical exam. You consider that:
You see a 54-year- old woman, Senora Sanchez, who is not fluent in speaking English, who comes into the emergency department chief complaint of abdominal pain and is accompanied by Tomas, her 10-year-old nephew. Tomas states, “I am here to help my
You see a 24-year- old mother who presents with her healthy 18-month-old son. He is being seen for a well child visit. An interac his examination is within normal limits. When you ask if the mom has any concerns, she states, “I do not like it when people sta get sick.” You respond:
For an individual to demonstrate the capability to make an informed healthcare decision, all of the following must be present ex
Your neighbor asks you to refill her high blood pressure medicine as she could not make her last office visit to her provider due t aware that she is going through a rough time personally and agree to call in the prescription. Is she now your patient?
A malpractice suit concerning a delayed cancer diagnosis is filed naming a NP in a primary care practice. Will the APRN be held with the same level of education and practice in primary care or in an oncology practice?
An APRN prescribes clarithromycin for the treatment of sinusitis in a woman taking simvastatin. While on the antibiotic, the pati Can you see a correlation between the above events?
Medicaid is the largest payer for nursing facility care.
Impoverishment is the primary requirement for Medicaid eligibility.
A person who is Medicaid eligible in one state might be deemed to be ineligible in another state.
The Medicare program pays for any services that are covered by Medicare before any payments are made by the Medicaid prog the payer of last resort.
True/False In keeping with HIPAA’s requirements:
1. You cannot announce a patient’s name in a waiting room.__
2. If interrupted during a patient visit, prior to leaving the exam room, the healthcare provider should lock or otherwise disable the electronic health record (EHR) to minimize the risk of unauthorized access to information.__
3. A healthcare provider can leave a patient a message on his or her answering machine unless specifically asked not to do so but the amount of information disclosed should be limited.__
4. Unless asked not to do so by the patient, a healthcare provider is allowed to leave a message with a family member or other person who answers the phone when the patient is not home.__
5. If interrupted during a patient visit, prior to leaving the exam room, the healthcare provider should take the paper healthcare record with him/her, in order to minimize the risk of unauthorized access to information.__
6. Unless under the control of the healthcare provider or staff, paper records should be kept in a secure location, such as a locked desk, locked filing cabinet or office with appropriate staff.__
7. An employee of a healthcare facility is only able to access patient records for legitimate, job-related purposes.__
8. If a patient requests a paper copy of his/ her record, the healthcare facility can charge a reasonable fee for this service.__
The APRN writes a prescription for trimethoprim-sulfamethoxazole for a patient who has a skin and soft tissue infection and known sulfa allergy. The patient takes two doses of the medication, has no reaction, then realizes this might be one of the problematic antibiotics. The patient notifies the practice and the APRN changes the medication. He makes a full recovery.
1. Is there negligence? __
2. Is there damage? __
A 45-year-old woman calls up your practice and speaks to the triage nurse, stating, “I am going to sue you all. That NP gave me have yeast infection.” Does this meet the “damages” standard?
Which information concerning the use of email messages is included in the Health Insurance Portability and Accountability Act?
Email messages containing private patient information are acceptable if the information is encrypted
Dental care for Medicaid enrollees under the age of 21 years is a basic requirement of the plan.
The services rendered under Medicaid that is provided by one state can differ considerably in amount, duration, or scope from s neighboring states.
What type of professional liability insurance policy covers you only if the injury occurs within the policy period and the claim is f policy is in effect?
Medicaid benefits are paid to the enrollee, then the enrollee is responsible for paying the healthcare bill. False
A clinical trial is studying whether a vaccine prevents disease. Among those who receive the vaccine, 10% get the disease comp placebo. In this case, the ARR is:
A clinical trial is studying whether a vaccine prevents disease. Among those who receive the vaccine, 10% get the disease comp placebo. In this case, the RRR is:
The relationship between obesity and type 2 diabetes is best described as:
A researcher wishes to evaluate the effectiveness of Antimicrobial Z for complicated skin infections by analyzing patient charts generally considered what type of study?
Billing and coding are basically the same thing.
CPT stands for:
Which of the following represents a valid ICD 10 code?
A new family nurse practitioner is beginning a practice in weight management. While reviewing the literature on techniques to promote weight loss, he finds a research report of 30 adult women who recorded their daily caloric intake on a new iPhone® application while on a weight loss plan. The women lost an average of 10% starting weight during the study. In the discussion section of the paper, the author suggested that based on these data, adult women who used this iPhone® application while on a weight loss plan would lose 10% of starting weight. The new FNP questions whether or not the iPhone® application is the cause of the weight loss.
A new family nurse practitioner is beginning a practice in weight management. While reviewing the literature on techniques to p research report of 30 adult women who recorded their daily caloric intake on a new iPhone® application while on a weight loss average of 10% starting weight during the study. In the discussion section of the paper, the author suggested that based on the used this iPhone® application while on a weight loss plan would lose 10% of starting weight. The new FNP questions whether or is the cause of the weight loss.
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